Emmett Lawrence Zimmerman, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

3387-06 Issued in MS

Practice address

13165 Vidalia Rd
Pass Christian, MS 39571-9162

Phone

(228) 255-4355

Fax

(228) 255-6761

NPI assigned

May 10, 2007

Sex

Male

Sole proprietor

Yes

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

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Zimmerman Family Dentistry

  • General Practice Dentistry
  • Pass Christian, MS
  • NPI 1780811828
  Authorized official Same address or phone
• Charles G. Wood D.M.D.P.a.

  • General Practice Dentistry
  • Gulfport, MS
  • NPI 1063430924
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435104000000",
    "number": "1700090594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13165 VIDALIA RD",
            "city": "PASS CHRISTIAN",
            "state": "MS",
            "postal_code": "395719162",
            "telephone_number": "228-255-4355",
            "fax_number": "228-255-6761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13165 VIDALIA RD",
            "city": "PASS CHRISTIAN",
            "state": "MS",
            "postal_code": "395719162",
            "telephone_number": "228-255-4355",
            "fax_number": "228-255-6761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "EMMETT",
        "middle_name": "LAWRENCE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2015-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3387-06",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Wiley, P.T.
• Molly Wilson, LPC-S
• Stella Pierce Wolf, RD
• Zimmerman Family Dental Dentistry Acquisition Pass Christian PLLC
• Zimmerman Family Dentistry
• Jeff Michael Zimmerman, DDS

• Dentist in Pass Christian, MS
• Providers in Pass Christian, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.