Provider Demographics
NPI:1912979469
Name:BACH, WENDY ZIMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ZIMAN
Last Name:BACH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:STE 425
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402
Mailing Address - Country:US
Mailing Address - Phone:612-332-7675
Mailing Address - Fax:612-305-1861
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:STE 425
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402
Practice Address - Country:US
Practice Address - Phone:612-332-7675
Practice Address - Fax:612-305-1861
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN88171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice