Provider Demographics
NPI:1336554484
Name:SIMMONS, TESS (DDS)
Entity Type:Individual
Prefix:DR
First Name:TESS
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 LA JOYA ST STE A
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2599
Mailing Address - Country:US
Mailing Address - Phone:505-753-2230
Mailing Address - Fax:505-753-7163
Practice Address - Street 1:704 LA JOYA ST STE A
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2599
Practice Address - Country:US
Practice Address - Phone:505-753-2230
Practice Address - Fax:505-753-7163
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10409122300000X
TX30027122300000X
NMDD44171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist