Organization
VAN R SIMMONS DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VAN R SIMMONS DMD (DENTIST)
(601) 684-6532
Entity
Organization
Contact information
Practice address
304 CLARKE AVE, MCCOMB, MS 39648
(601) 684-6532
(601) 684-6431
Mailing address
PO BOX 885, 304 CLARKE AVE, MCCOMB, MS 39648
(601) 684-6532
(601) 684-6431
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
194581
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00064894
—
MS
Enumeration date
11/03/2006
Last updated
08/22/2020
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