Provider Demographics
NPI:1063084085
Name:ZIMMERMAN, KATHRYN ELIZABETH
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 NEW HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-6708
Mailing Address - Country:US
Mailing Address - Phone:336-404-0693
Mailing Address - Fax:
Practice Address - Street 1:5314 W FRIENDLY AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4351
Practice Address - Country:US
Practice Address - Phone:336-299-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist