Provider Demographics
NPI:1841327228
Name:ZIMMERMAN, CURTIS ROBERT (DMD)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:ROBERT
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CURTIS
Other - Middle Name:ROBERT
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3935 DUPONT CIR
Mailing Address - Street 2:STE B
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4824
Mailing Address - Country:US
Mailing Address - Phone:502-899-2121
Mailing Address - Fax:502-899-2122
Practice Address - Street 1:504 BRIGHTWOOD PL
Practice Address - Street 2:APT B-2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5111
Practice Address - Country:US
Practice Address - Phone:502-599-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60004546Medicaid