Healthcare Provider Details

I. General information

NPI: 1679817340
Provider Name (Legal Business Name): CHRISTA LYNN ZIMMERMAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 SPRING VALLEY RD
LANCASTER PA
17601-2427
US

IV. Provider business mailing address

771 DOGWOOD LN
GAP PA
17527-9541
US

V. Phone/Fax

Practice location:
  • Phone: 717-481-7645
  • Fax: 717-481-7655
Mailing address:
  • Phone: 717-330-6119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH071112
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDHA001219
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: