Provider Demographics
NPI:1962558791
Name:ZIMMERMAN, JASON NATHANIEL SR (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:NATHANIEL
Last Name:ZIMMERMAN
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38000 ANN ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2453
Mailing Address - Country:US
Mailing Address - Phone:734-591-3636
Mailing Address - Fax:734-591-3355
Practice Address - Street 1:38000 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2453
Practice Address - Country:US
Practice Address - Phone:734-591-3636
Practice Address - Fax:734-591-3355
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010189401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901018940OtherLICENSE NUMBER