Provider Demographics
NPI:1083615660
Name:SIMMONS, PATRICIA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5902 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-4162
Mailing Address - Country:US
Mailing Address - Phone:708-780-0440
Mailing Address - Fax:708-780-0441
Practice Address - Street 1:5902 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4162
Practice Address - Country:US
Practice Address - Phone:708-780-0440
Practice Address - Fax:708-780-0441
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice