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General NPI Number Information
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NPI Number | 1457771651
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Entity Type | Organization
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Legal Business Name | CRAIG A. SIMMONS, D. D. S.
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Dates
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Enumeration Date | 04/27/2014
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Last Update Date | 04/27/2014
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Provider Practice Location Address
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Address Line | 4955 W TAFT RD
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City | LIVERPOOL
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State | NY
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Zip | 13088-4764
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Country | US
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Telephone | 315-453-9186
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Fax |
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Provider Business Mailing Address
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Address Line | 4955 W TAFT RD
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City | LIVERPOOL
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State | NY
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Zip | 13088-4764
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Country | US
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Telephone | 315-453-9186
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CRAIG A SIMMONS
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Credential | DDS
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Telephone | 315-453-9186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 035032
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License Number State | NY
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