Healthcare Provider Details

I. General information

NPI: 1457425993
Provider Name (Legal Business Name): RAYMOND KENNETH SIMMONS DDS, DMSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE
LONG BRANCH NJ
07740-6303
US

IV. Provider business mailing address

300 2ND AVE
LONG BRANCH NJ
07740-6303
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-6586
  • Fax: 732-923-6599
Mailing address:
  • Phone: 732-923-6586
  • Fax: 732-923-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI02526800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: