Healthcare Provider Details

I. General information

NPI: 1487279519
Provider Name (Legal Business Name): NGOC-ANH THI SIMMS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40470 GERMANY RD
GONZALES LA
70737-6735
US

IV. Provider business mailing address

721 HOUMA BLVD
METAIRIE LA
70001-4730
US

V. Phone/Fax

Practice location:
  • Phone: 225-622-2022
  • Fax:
Mailing address:
  • Phone: 225-802-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7081
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: