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NPI Code Detail

MEDICARE: DR. THOMAS ALAN SIMMONS DDS

MEDICARE: DR. THOMAS ALAN SIMMONS DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2901012153MI

General Provider Information

NPI Number : 1295713691
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS ALAN SIMMONS DDS
Provider Business Mailing Address
First Line : PO BOX 627
Second Line :
City : PORT SANILAC
State : MI
Zip : 48469-0627
Country : US
Telephone Number : 810-622-8230
Fax Number :
Provider Business Practice Location Address
First Line : 245 S RIDGE ST
Second Line :
City : PORT SANILAC
State : MI
Zip : 48469-9704
Country : US
Telephone Number : 810-622-8230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 07/08/2007

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