Healthcare Provider Details

I. General information

NPI: 1972177780
Provider Name (Legal Business Name): GABRIELA ALEJANDRA ZIMMER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELA ALEJANDRA IBARRA DDS

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

305 W. 12TH AVENUE 3005R POSTLE HALL
COLUMBUS OH
43210-5742
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-1097
  • Fax: 614-247-8011
Mailing address:
  • Phone: 614-292-1097
  • Fax: 614-247-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.026775
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD14651
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: