1710970389 NPI number — DR. MARK ANDREW SIMMONS D.D.S.

Table of content: DR. MARK ANDREW SIMMONS D.D.S. (NPI 1710970389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710970389 NPI number — DR. MARK ANDREW SIMMONS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMONS
Provider First Name:
MARK
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
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:
1710970389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/17/2006
NPI Reactivation Date:
03/22/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1294
Provider Second Line Business Mailing Address:
13549 US HWY 87 W
Provider Business Mailing Address City Name:
LA VERNIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78121-5879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-779-6511
Provider Business Mailing Address Fax Number:
830-779-1711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13549 US HWY 87 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA VERNIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78121-5879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-779-6511
Provider Business Practice Location Address Fax Number:
830-779-1711
Provider Enumeration Date:
08/29/2005

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:  TX14122 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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