Healthcare Provider Details

I. General information

NPI: 1689818692
Provider Name (Legal Business Name): DAVID J GIMMARRO, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 N MERRIMAN RD
WESTLAND MI
48185-1608
US

IV. Provider business mailing address

8001 N MERRIMAN RD
WESTLAND MI
48185-1608
US

V. Phone/Fax

Practice location:
  • Phone: 734-522-6470
  • Fax: 734-522-6937
Mailing address:
  • Phone: 734-522-6470
  • Fax: 734-522-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2901015423
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number019022356
License Number StateIL

VIII. Authorized Official

Name: NICOLE L GOSSMAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 734-522-6470