Provider Demographics
NPI:1821010661
Name:ZIMMERMAN, FREDERICK RAYMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:RAYMOND
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 BURNT TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1472
Mailing Address - Country:US
Mailing Address - Phone:732-458-7500
Mailing Address - Fax:732-840-6619
Practice Address - Street 1:1139 BURNT TAVERN RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1472
Practice Address - Country:US
Practice Address - Phone:732-458-7500
Practice Address - Fax:732-840-6619
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ151441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice