Provider Demographics
NPI:1366173304
Name:ZIMBELMAN, MEGAN MAKENA (DMD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MAKENA
Last Name:ZIMBELMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 S OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2182
Mailing Address - Country:US
Mailing Address - Phone:816-383-2627
Mailing Address - Fax:
Practice Address - Street 1:1700 W CHARLESTON BLVD BLDG D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2335
Practice Address - Country:US
Practice Address - Phone:702-774-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist