Samuel Reed Zimmer, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2018017727 Issued in MO

Practice address

609 E Wells St Ste F
Ash Grove, MO 65604-7374

Phone

(417) 751-9772

Fax

(417) 751-9186

NPI assigned

Jun 4, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clear Creek Family Dental Rogersville

  • Dental Clinic/Center
  • Rogersville, MO
  • NPI 1114633922
  NPD Authorized official
• Clear Creek Family Dental

  • Dentist
  • Ash Grove, MO
  • NPI 1700715729
  NPD (past)
• Clear Creek Family Dental

  • General Practice Dentistry
  • Ash Grove, MO
  • NPI 1962725184
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528070400000",
    "number": "1245722479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5944 E FARM ROAD 186",
            "city": "ROGERSVILLE",
            "state": "MO",
            "postal_code": "657426433",
            "telephone_number": "417-569-4083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 E WELLS ST STE F",
            "city": "ASH GROVE",
            "state": "MO",
            "postal_code": "656047374",
            "telephone_number": "417-751-9772",
            "fax_number": "417-751-9186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMER",
        "first_name": "SAMUEL",
        "middle_name": "REED",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-04",
        "last_updated": "2018-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2018017727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Ash Grove, MO
• Providers in Ash Grove, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.