Provider Demographics
NPI:1619035649
Name:SIMMONS, DONALD AMALGA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:AMALGA
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4103
Mailing Address - Country:US
Mailing Address - Phone:479-890-6174
Mailing Address - Fax:479-967-0339
Practice Address - Street 1:402 E PARKWAY DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4103
Practice Address - Country:US
Practice Address - Phone:479-890-6174
Practice Address - Fax:479-967-0339
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice