Provider Demographics
NPI:1447622436
Name:SHIRLEY F SIMMONDS DMD PA
Entity type:Organization
Organization Name:SHIRLEY F SIMMONDS DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SIMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-253-7670
Mailing Address - Street 1:9000 SW 152ND ST STE 208
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1942
Mailing Address - Country:US
Mailing Address - Phone:305-253-7670
Mailing Address - Fax:
Practice Address - Street 1:9000 SW 152ND ST STE 208
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1942
Practice Address - Country:US
Practice Address - Phone:305-253-7670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty