Provider Demographics
NPI:1033604152
Name:SIMMONETT, STEPHANIE ELAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ELAM
Last Name:SIMMONETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:ELAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2250 CLARENDON BLVD APT 520
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3334
Mailing Address - Country:US
Mailing Address - Phone:706-399-3831
Mailing Address - Fax:
Practice Address - Street 1:2112 F ST NW STE 603
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2762
Practice Address - Country:US
Practice Address - Phone:202-466-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-01
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10018661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice