Provider Demographics
NPI:1952327561
Name:SIMM, ADRIAN MICHAEL SR (DDS)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:MICHAEL
Last Name:SIMM
Suffix:SR
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:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:DELCAMBRE
Mailing Address - State:LA
Mailing Address - Zip Code:70528
Mailing Address - Country:US
Mailing Address - Phone:337-685-2274
Mailing Address - Fax:337-685-5543
Practice Address - Street 1:506 WEST MAIN
Practice Address - Street 2:
Practice Address - City:DELCAMBRE
Practice Address - State:LA
Practice Address - Zip Code:70528
Practice Address - Country:US
Practice Address - Phone:337-685-2274
Practice Address - Fax:337-685-5543
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1830267Medicaid