Provider Demographics
NPI:1164970943
Name:SIMMONS, ANN (DMD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 CARMITA AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1630
Mailing Address - Country:US
Mailing Address - Phone:646-461-0454
Mailing Address - Fax:
Practice Address - Street 1:571 N 6TH ST FL 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2501
Practice Address - Country:US
Practice Address - Phone:973-485-5429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02648700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist