Provider Demographics
NPI:1164540795
Name:E. WAYNE SIMMONS, D.M.D., PROSTHODONTIST, PC
Entity Type:Organization
Organization Name:E. WAYNE SIMMONS, D.M.D., PROSTHODONTIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:E.
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:210-692-0136
Mailing Address - Street 1:2020 BABCOCK RD
Mailing Address - Street 2:BOX 25
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4443
Mailing Address - Country:US
Mailing Address - Phone:210-692-0136
Mailing Address - Fax:210-692-0139
Practice Address - Street 1:2020 BABCOCK RD
Practice Address - Street 2:SUITE 24
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4443
Practice Address - Country:US
Practice Address - Phone:210-692-0136
Practice Address - Fax:210-692-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108361223P0700X
SC18641223P0700X
TX220751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty