Provider Demographics
NPI:1265583124
Name:ROBERT L. SIMMONS, DMD, PSC
Entity type:Organization
Organization Name:ROBERT L. SIMMONS, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-932-4286
Mailing Address - Street 1:2619 CAMPBELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-9703
Mailing Address - Country:US
Mailing Address - Phone:270-932-4286
Mailing Address - Fax:270-932-4267
Practice Address - Street 1:2619 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-9703
Practice Address - Country:US
Practice Address - Phone:270-932-4286
Practice Address - Fax:270-932-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60070166Medicaid
KY6190040300Medicaid