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General NPI Number Information
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NPI Number | 1144193939
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Entity Type | Organization
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Legal Business Name | ZACKERY SIMONS DDS PLLC
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Dates
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Enumeration Date | 09/26/2025
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 3800 SOUTHPARK DR
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City | TYLER
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State | TX
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Zip | 75703-1713
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Country | US
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Telephone | 903-581-8882
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 SOUTHPARK DR
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City | TYLER
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State | TX
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Zip | 75703-1713
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ZACKERY SIMONS
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Credential |
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Telephone | 903-315-6515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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