Provider Demographics
NPI:1669099784
Name:SIMONS, SKYLER BROOKE (DMD)
Entity type:Individual
Prefix:DR
First Name:SKYLER
Middle Name:BROOKE
Last Name:SIMONS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 AUGUSTUS DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-8207
Mailing Address - Country:US
Mailing Address - Phone:229-376-3943
Mailing Address - Fax:
Practice Address - Street 1:138 OAKLAND PKWY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-7200
Practice Address - Country:US
Practice Address - Phone:229-432-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN016090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist