Provider Demographics
NPI:1972177780
Name:ZIMMER, GABRIELA ALEJANDRA (DDS)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ALEJANDRA
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:ALEJANDRA
Other - Last Name:IBARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:305 W. 12TH AVENUE
Mailing Address - Street 2:3005R POSTLE HALL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-5742
Mailing Address - Country:US
Mailing Address - Phone:614-292-1097
Mailing Address - Fax:614-247-8011
Practice Address - Street 1:305 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-292-1097
Practice Address - Fax:614-247-8011
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND146511223S0112X
OH30.026775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery