Provider Demographics
NPI:1417054420
Name:ZIMMERMAN, JOSEPH C III (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:ZIMMERMAN
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 W JEFFERSON ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550
Mailing Address - Country:US
Mailing Address - Phone:309-263-8317
Mailing Address - Fax:309-263-2175
Practice Address - Street 1:636 W JEFFERSON ST
Practice Address - Street 2:SUITE 8
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550
Practice Address - Country:US
Practice Address - Phone:309-263-8317
Practice Address - Fax:309-263-2175
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A15922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist