Provider Demographics
NPI:1710970389
Name:SIMMONS, MARK ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
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:P.O. BOX 1294
Mailing Address - Street 2:13549 US HWY 87 W
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5879
Mailing Address - Country:US
Mailing Address - Phone:830-779-6511
Mailing Address - Fax:830-779-1711
Practice Address - Street 1:13549 US HWY 87 W
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-5879
Practice Address - Country:US
Practice Address - Phone:830-779-6511
Practice Address - Fax:830-779-1711
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2013-01-28
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
TXTX141221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice