Provider Demographics
NPI:1538299185
Name:SIMMONDS, SHIRLEY F (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:F
Last Name:SIMMONDS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SW 152ND ST
Mailing Address - Street 2:208
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1981
Mailing Address - Country:US
Mailing Address - Phone:305-253-7670
Mailing Address - Fax:305-254-0969
Practice Address - Street 1:9000 SW 152ND ST
Practice Address - Street 2:208
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1981
Practice Address - Country:US
Practice Address - Phone:305-253-7670
Practice Address - Fax:305-254-0969
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL DN131711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL072926000Medicaid