Provider Demographics
NPI:1396033148
Name:SIMMONS, JENNIFER LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
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 1:726 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-2035
Mailing Address - Country:US
Mailing Address - Phone:901-476-0661
Mailing Address - Fax:
Practice Address - Street 1:726 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-2035
Practice Address - Country:US
Practice Address - Phone:901-476-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9317OtherTENNESSEE LICENSE NUMBER