Provider Demographics
NPI:1437169620
Name:SIMONS, JAMES KIRK (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KIRK
Last Name:SIMONS
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 1:2700 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5421
Mailing Address - Country:US
Mailing Address - Phone:512-442-4338
Mailing Address - Fax:512-442-6074
Practice Address - Street 1:2700 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5421
Practice Address - Country:US
Practice Address - Phone:512-442-4338
Practice Address - Fax:512-442-6074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60054-01OtherCHIP ID