Provider Demographics
NPI:1346779402
Name:ZIMMERMAN, LORI PRICE (DMD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:PRICE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3815
Mailing Address - Country:US
Mailing Address - Phone:864-595-1203
Mailing Address - Fax:864-587-2879
Practice Address - Street 1:127 SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3815
Practice Address - Country:US
Practice Address - Phone:864-595-1203
Practice Address - Fax:864-587-2879
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice