# S.L. SIMMONS-BOYD, D.D.S., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609045335
- **Authorized official:** DR. SANDRA SIMMONS-BOYD D.D.S (PRESIDENT)
- **Authorized official phone:** (704) 376-1696

## Contact information

- **Practice address:** 725 PROVIDENCE RD, SUITE 301, CHARLOTTE, NC 28207-2260
- **Practice address phone:** (704) 376-1696
- **Practice address fax:** (704) 376-1698
- **Mailing address:** 725 PROVIDENCE RD, SUITE 301, CHARLOTTE, NC 28207-2370
- **Mailing address phone:** (704) 376-1696
- **Mailing address fax:** (704) 376-1698

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6088 | NC | Yes |

## Other

- **Enumeration date:** 02/27/2008
- **Last updated:** 08/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6088 | NC STATE LICENSE | NC |
| 05 | — | 8997795 | — | NC |
| 01 | — | 97795 | BCBS PROVIDER NUMBER | NC |