Provider Demographics
NPI:1518037522
Name:SIMMS, DARRYL AUSTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:AUSTIN
Last Name:SIMMS
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 1:599 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5156
Mailing Address - Country:US
Mailing Address - Phone:860-647-7663
Mailing Address - Fax:
Practice Address - Street 1:599 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5156
Practice Address - Country:US
Practice Address - Phone:860-647-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83511223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT8351OtherSTATE LICENSE #