Provider Demographics
NPI:1649563677
Name:V. I. PERIODONTICS, LLC
Entity Type:Organization
Organization Name:V. I. PERIODONTICS, LLC
Other - Org Name:TREVOR SIMMONDS, DDS, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SIMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:340-779-2009
Mailing Address - Street 1:71 VALLEY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2835
Mailing Address - Country:US
Mailing Address - Phone:973-761-0961
Mailing Address - Fax:
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE AMALIE
Practice Address - State:VI
Practice Address - Zip Code:00802-2615
Practice Address - Country:US
Practice Address - Phone:340-779-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREVOR SIMMONDS, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI10191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty