Provider Demographics
NPI:1326148636
Name:SIMMONS, ALAN RAMON (DDS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:RAMON
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 W GRAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-5419
Mailing Address - Country:US
Mailing Address - Phone:713-529-3597
Mailing Address - Fax:713-529-9169
Practice Address - Street 1:277 W GRAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-5419
Practice Address - Country:US
Practice Address - Phone:713-529-3597
Practice Address - Fax:713-529-9169
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19218TT1223E0200X
TX192181223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX007937801Medicaid