Provider Demographics
NPI:1659495612
Name:C. T. SIMMS, D.D.S., P.C.
Entity Type:Organization
Organization Name:C. T. SIMMS, D.D.S., P.C.
Other - Org Name:C. TOM SIMMS, D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-758-8303
Mailing Address - Street 1:1392 WEIMER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-1931
Mailing Address - Country:US
Mailing Address - Phone:505-758-8303
Mailing Address - Fax:505-737-5737
Practice Address - Street 1:1392 WEIMER RD
Practice Address - Street 2:SUITE B
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-1931
Practice Address - Country:US
Practice Address - Phone:505-758-8303
Practice Address - Fax:505-737-5737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD10781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty