Healthcare Provider Details

I. General information

NPI: 1083424311
Provider Name (Legal Business Name): ZIMMERMAN FAMILY DENTISTRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W PENN ST
MARTINSBURG PA
16662-1113
US

IV. Provider business mailing address

114 W PENN ST
MARTINSBURG PA
16662-1113
US

V. Phone/Fax

Practice location:
  • Phone: 814-793-4362
  • Fax: 814-793-4362
Mailing address:
  • Phone: 814-793-4362
  • Fax: 814-793-4362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN LUKE ZIMMERMAN
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 814-494-1135