Provider Demographics
NPI:1578929493
Name:MCMAHON SIMMONS, MARLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:
Last Name:MCMAHON SIMMONS
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 1:198 RUTLEDGE AVE
Mailing Address - Street 2:#3
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5817
Mailing Address - Country:US
Mailing Address - Phone:843-723-5405
Mailing Address - Fax:
Practice Address - Street 1:198 RUTLEDGE AVE
Practice Address - Street 2:#3
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5817
Practice Address - Country:US
Practice Address - Phone:843-723-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist