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NPI Code Detail

MEDICARE: DR. BRANDI SIMMONS DMD

MEDICARE: DR. BRANDI SIMMONS DMD
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
1122300000XDentist9379KY
2122300000XDentistDN20818FL

General Provider Information

NPI Number : 1992120554
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRANDI SIMMONS DMD
Provider Business Mailing Address
First Line : 2350 S HIGHWAY 29
Second Line :
City : CANTONMENT
State : FL
Zip : 32533-8508
Country : US
Telephone Number : 850-968-2106
Fax Number :
Provider Business Practice Location Address
First Line : 2350 S HIGHWAY 29
Second Line :
City : CANTONMENT
State : FL
Zip : 32533-8508
Country : US
Telephone Number : 850-968-2106
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2014
Last Update Date : 12/14/2016

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