Provider Demographics
NPI:1821226481
Name:ZIMMERMAN, ROMY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ROMY
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5556 CLAY CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0704
Mailing Address - Country:US
Mailing Address - Phone:817-652-6764
Mailing Address - Fax:
Practice Address - Street 1:715 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4520
Practice Address - Country:US
Practice Address - Phone:972-298-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15319124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist