Provider Demographics
NPI:1629034277
Name:SIMMONS, RONNY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONNY
Middle Name:MICHAEL
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 1:3139 RUSTIC OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2211
Mailing Address - Country:US
Mailing Address - Phone:830-980-4949
Mailing Address - Fax:
Practice Address - Street 1:12TH ADS/SGGD
Practice Address - Street 2:221 3RD STREET WEST, BLDG 1040
Practice Address - City:RANDOLPH AFB
Practice Address - State:TX
Practice Address - Zip Code:78150-4801
Practice Address - Country:US
Practice Address - Phone:210-652-1846
Practice Address - Fax:210-652-1368
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice