Provider Demographics
NPI:1265453591
Name:SIMMONDS,BRADY&LOI ORAL AND MAXILLOFACIAL SURGERY AND IMPLANT SPECIALI
Entity Type:Organization
Organization Name:SIMMONDS,BRADY&LOI ORAL AND MAXILLOFACIAL SURGERY AND IMPLANT SPECIALI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONDS-BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-253-8408
Mailing Address - Street 1:19 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4058
Mailing Address - Country:US
Mailing Address - Phone:315-253-8408
Mailing Address - Fax:315-258-8136
Practice Address - Street 1:19 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4058
Practice Address - Country:US
Practice Address - Phone:315-253-8408
Practice Address - Fax:315-258-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02366278Medicaid