Healthcare Provider Details

I. General information

NPI: 1083615660
Provider Name (Legal Business Name): PATRICIA LYNN SIMMONS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5902 W 35TH ST
CICERO IL
60804-4162
US

IV. Provider business mailing address

5902 W 35TH ST
CICERO IL
60804-4162
US

V. Phone/Fax

Practice location:
  • Phone: 708-780-0440
  • Fax: 708-780-0441
Mailing address:
  • Phone: 708-780-0440
  • Fax: 708-780-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: