Provider Demographics
NPI:1639303902
Name:ZIMMERMAN, TAMARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SEATON GATE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1198
Mailing Address - Country:US
Mailing Address - Phone:516-825-9500
Mailing Address - Fax:516-825-4718
Practice Address - Street 1:5 SEATON GATE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1198
Practice Address - Country:US
Practice Address - Phone:516-825-9500
Practice Address - Fax:516-825-4718
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0532601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice