Provider Demographics
NPI:1831316884
Name:ZIMMERMANN, TOM CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:CHARLES
Last Name:ZIMMERMANN
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 1:3855 W 7800 S
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5560
Mailing Address - Country:US
Mailing Address - Phone:801-260-0530
Mailing Address - Fax:801-260-0533
Practice Address - Street 1:3855 W 7800 S
Practice Address - Street 2:SUITE 150
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5560
Practice Address - Country:US
Practice Address - Phone:801-260-0530
Practice Address - Fax:801-260-0533
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT136792-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice