Provider Demographics
NPI:1508983107
Name:SIMMONS, E. WAYNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:E.
Middle Name:WAYNE
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 BABCOCK RD
Mailing Address - Street 2:BOX 25
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4443
Mailing Address - Country:US
Mailing Address - Phone:210-692-0136
Mailing Address - Fax:210-692-1039
Practice Address - Street 1:2020 BABCOCK RD
Practice Address - Street 2:SUITE 24
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4443
Practice Address - Country:US
Practice Address - Phone:210-692-0136
Practice Address - Fax:210-692-0139
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108361223P0700X
SC18641223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics