Provider Demographics
NPI:1245722479
Name:ZIMMER, SAMUEL REED (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:REED
Last Name:ZIMMER
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 1:5944 E FARM ROAD 186
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-6433
Mailing Address - Country:US
Mailing Address - Phone:417-569-4083
Mailing Address - Fax:
Practice Address - Street 1:609 E WELLS ST STE F
Practice Address - Street 2:
Practice Address - City:ASH GROVE
Practice Address - State:MO
Practice Address - Zip Code:65604-7374
Practice Address - Country:US
Practice Address - Phone:417-751-9772
Practice Address - Fax:417-751-9186
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018017727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist