Provider Demographics
NPI:1700201225
Name:JEREMY SIMMONS, PLLC
Entity Type:Organization
Organization Name:JEREMY SIMMONS, PLLC
Other - Org Name:NOVA FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-989-0979
Mailing Address - Street 1:6738 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1210
Mailing Address - Country:US
Mailing Address - Phone:281-989-0979
Mailing Address - Fax:
Practice Address - Street 1:6738 FOREST HILL DR
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76140-1210
Practice Address - Country:US
Practice Address - Phone:281-989-0979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty