Basic Information
| Provider Information | |||||||||
| NPI: | 1518029339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 W 6TH | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057076135 | ||||||||
| FaxNumber: | 4057070602 | ||||||||
| Practice Location | |||||||||
| Address1: | 47 NE 23RD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056012763 | ||||||||
| FaxNumber: | 4056013783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 12/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 2947 | OK | Y | Dental Providers | Dentist | General Practice |
No ID Information.