Provider Demographics
NPI:1679316707
Name:ZIMMERMAN, MATTHEW TODD (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TODD
Last Name:ZIMMERMAN
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 1:9023 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2937
Mailing Address - Country:US
Mailing Address - Phone:913-488-2018
Mailing Address - Fax:
Practice Address - Street 1:4546 MAIN ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1816
Practice Address - Country:US
Practice Address - Phone:816-931-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240220331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice