MEDICARE: MRS. COREY ZIMMERMAN RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	3920	SC

General Provider Information

NPI Number	:	1174370944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COREY ZIMMERMAN RDH

Provider Business Mailing Address
First Line	:	3201 MAYBANK HWY
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-4817
Country	:	US
Telephone Number	:	843-559-3135
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 MAYBANK HWY
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-4817
Country	:	US
Telephone Number	:	843-559-3135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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