Provider Demographics
NPI:1902058217
Name:ZIMNY, DANIEL R (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:ZIMNY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WELLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-2229
Mailing Address - Country:US
Mailing Address - Phone:317-398-4650
Mailing Address - Fax:317-398-4775
Practice Address - Street 1:301 WELLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-2229
Practice Address - Country:US
Practice Address - Phone:317-398-4650
Practice Address - Fax:317-398-4775
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120071091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice