=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063084085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. KATHRYN ELIZABETH ZIMMERMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2021
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5314 W FRIENDLY AVE STE A
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27410-4351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-299-8530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2918 NEW HANOVER DR
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27408-6708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-404-0693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 12337
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------