Provider Demographics
NPI:1518005420
Name:SIMMONS, MARICELA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARICELA
Middle Name:M
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 1:7035 PARTRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-5013
Mailing Address - Country:US
Mailing Address - Phone:760-634-0500
Mailing Address - Fax:760-634-1096
Practice Address - Street 1:351 SANTA FE DR
Practice Address - Street 2:STE # 230
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5137
Practice Address - Country:US
Practice Address - Phone:760-634-0500
Practice Address - Fax:760-634-1096
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice