Healthcare Provider Details

I. General information

NPI: 1902874159
Provider Name (Legal Business Name): JASON A ZIMMERMAN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2006
Last Update Date: 10/23/2022
Certification Date: 10/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 BELLAIRE DR S STE 4
FORT WORTH TX
76109-1811
US

IV. Provider business mailing address

PO BOX 55367
HURST TX
76054-5367
US

V. Phone/Fax

Practice location:
  • Phone: 214-533-8183
  • Fax: 817-796-2404
Mailing address:
  • Phone: 214-533-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number20465
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number20465
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: