Provider Demographics
NPI:1740413863
Name:ZIMMER, ANDREW J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
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 1:1604 HILLTOP WEST CTR
Mailing Address - Street 2:SUITE 216
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6141
Mailing Address - Country:US
Mailing Address - Phone:757-491-5070
Mailing Address - Fax:757-491-2528
Practice Address - Street 1:1604 HILLTOP WEST CTR
Practice Address - Street 2:SUITE 216
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6141
Practice Address - Country:US
Practice Address - Phone:757-491-5070
Practice Address - Fax:757-491-2528
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010040381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice