Provider Demographics
NPI:1487921151
Name:ZIMMERS, PAM (DDS)
Entity type:Individual
Prefix:DR
First Name:PAM
Middle Name:
Last Name:ZIMMERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAM
Other - Middle Name:
Other - Last Name:ZIMMERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2167 US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2805
Mailing Address - Country:US
Mailing Address - Phone:219-322-7898
Mailing Address - Fax:
Practice Address - Street 1:2167 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2805
Practice Address - Country:US
Practice Address - Phone:219-322-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010583A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist