Provider Demographics
NPI:1578869442
Name:SIMMONS, GERALD S (BDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:S
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 ELIZABETH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3810
Mailing Address - Country:US
Mailing Address - Phone:661-947-3163
Mailing Address - Fax:661-947-0538
Practice Address - Street 1:1029 ELIZABETH LAKE RD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3810
Practice Address - Country:US
Practice Address - Phone:661-947-3163
Practice Address - Fax:661-947-0538
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31979122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist