Organization
FRED H SIMMONS JR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED H SIMMONS JR. D.D.S.,M.S.D. (OWNER)
(812) 232-1138
Entity
Organization
Contact information
Practice address
3404 S 7TH ST, TERRE HAUTE, IN 47802-4017
(812) 232-1138
Mailing address
3404 S 7TH ST, TERRE HAUTE, IN 47802-4017
(812) 232-1138
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12006984
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100250180A
—
IN
Enumeration date
02/23/2010
Last updated
02/23/2010
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