Provider Demographics
NPI:1942486410
Name:ZIMMERMAN, SAM DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:DAVID
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:6 ISELIN LN
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1191
Mailing Address - Country:US
Mailing Address - Phone:732-544-2067
Mailing Address - Fax:
Practice Address - Street 1:6 ISELIN LN
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1191
Practice Address - Country:US
Practice Address - Phone:732-544-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1008537001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice