Healthcare Provider Details

I. General information

NPI: 1740407709
Provider Name (Legal Business Name): TOM C. ZIMMERMANN, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 W 7800 S SUITE 150
WEST JORDAN UT
84088-5560
US

IV. Provider business mailing address

3855 W 7800 S SUITE 150
WEST JORDAN UT
84088-5560
US

V. Phone/Fax

Practice location:
  • Phone: 801-260-0530
  • Fax: 801-260-0533
Mailing address:
  • Phone: 801-260-0530
  • Fax: 801-260-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number136792-9922
License Number StateUT

VIII. Authorized Official

Name: DR. TOM CHARLES ZIMMERMANN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 801-260-0530