Provider Demographics
NPI:1902874159
Name:ZIMMERMAN, JASON A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55367
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-5367
Mailing Address - Country:US
Mailing Address - Phone:214-533-8183
Mailing Address - Fax:
Practice Address - Street 1:4545 BELLAIRE DR S STE 4
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1811
Practice Address - Country:US
Practice Address - Phone:214-533-8183
Practice Address - Fax:817-796-2404
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-12
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20465122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151049709Medicaid