MEDICARE: CALEB SIMMONS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9473	GA

General Provider Information

NPI Number	:	1891715421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB SIMMONS DDS

Provider Business Mailing Address
First Line	:	2829 SCENIC TER
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-5841
Country	:	US
Telephone Number	:	404-762-7572
Fax Number	:

Provider Business Practice Location Address
First Line	:	1871 WASHINGTON AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-4128
Country	:	US
Telephone Number	:	404-761-7297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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