Individual
TAVIAN SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
550 N. UNIVERSITY BLVD STE. 3195, INDIANAPOLIS, IN 46202-0001
(317) 274-5315
Mailing address
6729 STANHOPE DR, INDIANAPOLIS, IN 46254
(252) 642-4822
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12014152A
IN
1223G0001X
General Practice Dentistry
12736
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/16/2022
Last updated
06/26/2023
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