Organization
S.L. SIMMONS-BOYD, D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANDRA SIMMONS-BOYD D.D.S (PRESIDENT)
(704) 376-1696
Entity
Organization
Contact information
Practice address
725 PROVIDENCE RD, SUITE 301, CHARLOTTE, NC 28207-2260
(704) 376-1696
(704) 376-1698
Mailing address
725 PROVIDENCE RD, SUITE 301, CHARLOTTE, NC 28207-2370
(704) 376-1696
(704) 376-1698
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6088
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6088
NC STATE LICENSE
NC
05
—
8997795
—
NC
01
—
97795
BCBS PROVIDER NUMBER
NC
Enumeration date
02/27/2008
Last updated
08/15/2008
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