Healthcare Provider Details

I. General information

NPI: 1669686705
Provider Name (Legal Business Name): RICHARD A. SIMMS, D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25617 DODGE AVE
HARBOR CITY CA
90710-3101
US

IV. Provider business mailing address

25617 DODGE AVE
HARBOR CITY CA
90710-3101
US

V. Phone/Fax

Practice location:
  • Phone: 310-835-3144
  • Fax: 310-830-4966
Mailing address:
  • Phone: 310-835-3144
  • Fax: 310-830-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JUDY ANN DOMINGUEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-835-3144