1164421657 NPI number — MR. ALLEN HIRCH SIMMONS D.D.S.

Table of content: MR. ALLEN HIRCH SIMMONS D.D.S. (NPI 1164421657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164421657 NPI number — MR. ALLEN HIRCH SIMMONS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMONS
Provider First Name:
ALLEN
Provider Middle Name:
HIRCH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164421657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7770 N FRESNO ST
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-431-1772
Provider Business Mailing Address Fax Number:
559-431-0506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7770 N FRESNO ST
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-2412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-431-1772
Provider Business Practice Location Address Fax Number:
559-431-0506
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  16829 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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