Provider Demographics
NPI:1467772459
Name:ZIMMER, DANIELA ROSE-MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:ROSE-MARIE
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:ROSE-MARIE
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10320 COTTONWOOD PARK NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114
Mailing Address - Country:US
Mailing Address - Phone:505-897-1416
Mailing Address - Fax:
Practice Address - Street 1:10320 COTTONWOOD PARK NW
Practice Address - Street 2:#D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-7008
Practice Address - Country:US
Practice Address - Phone:505-897-1416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36240122300000X
NMDD23231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist