Provider Demographics
NPI:1972866267
Name:MICHAEL S AND PAMELA SIMMONS
Entity Type:Organization
Organization Name:MICHAEL S AND PAMELA SIMMONS
Other - Org Name:ENCINO CENTER FOR SLEEP & TMJ DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-300-0070
Mailing Address - Street 1:16500 VENTURA BLVD STE 370
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2049
Mailing Address - Country:US
Mailing Address - Phone:818-300-0070
Mailing Address - Fax:818-300-0060
Practice Address - Street 1:16500 VENTURA BLVD STE 370
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2049
Practice Address - Country:US
Practice Address - Phone:818-300-0070
Practice Address - Fax:818-300-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA229916332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment