Individual
VAN ROBERT SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
304 CLARK AVE, MCCOMB, MS 39648-3968
(601) 684-6532
(601) 684-6431
Mailing address
304 CLARK AVE, MCCOMB, MS 39648-3968
(601) 684-6532
(601) 684-6431
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1945-81
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00064894
—
MS
Enumeration date
07/02/2013
Last updated
07/02/2013
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