Provider Demographics
NPI:1790703866
Name:SIMMONS, MATTHEW E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
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 1:316 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2620
Mailing Address - Country:US
Mailing Address - Phone:814-453-4491
Mailing Address - Fax:814-456-1481
Practice Address - Street 1:316 W 23RD ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2620
Practice Address - Country:US
Practice Address - Phone:814-453-4491
Practice Address - Fax:814-456-1481
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028457L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU78079Medicare UPIN
PA051528Medicare ID - Type Unspecified