Provider Demographics
NPI:1790820025
Name:SIMMONS, STEVEN M (DMD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SW 11TH
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205
Mailing Address - Country:US
Mailing Address - Phone:503-223-4993
Mailing Address - Fax:503-223-7225
Practice Address - Street 1:833 SW 11TH
Practice Address - Street 2:SUITE 800
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205
Practice Address - Country:US
Practice Address - Phone:503-223-4993
Practice Address - Fax:503-223-7225
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR55981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice