Provider Demographics
NPI:1639137052
Name:ZIMMER, DONALD JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOHN
Last Name:ZIMMER
Suffix:
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 1:601 E HAMPDEN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2769
Mailing Address - Country:US
Mailing Address - Phone:303-788-6462
Mailing Address - Fax:303-781-9763
Practice Address - Street 1:601 E HAMPDEN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3781
Practice Address - Country:US
Practice Address - Phone:303-788-6462
Practice Address - Fax:303-781-9763
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02040988Medicaid