Provider Demographics
NPI:1306857644
Name:SIMMONS, CELITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CELITA
Middle Name:
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 1:325 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3748
Mailing Address - Country:US
Mailing Address - Phone:501-778-8241
Mailing Address - Fax:501-776-3898
Practice Address - Street 1:325 SHORT ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3748
Practice Address - Country:US
Practice Address - Phone:501-778-8241
Practice Address - Fax:501-776-3898
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR29731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice