Provider Demographics
NPI:1700907870
Name:SIMMONS, RODGER LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODGER
Middle Name:LEE
Last Name:SIMMONS
Suffix:
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 1:601 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7229
Mailing Address - Country:US
Mailing Address - Phone:660-826-1733
Mailing Address - Fax:660-826-1733
Practice Address - Street 1:601 W 16TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7229
Practice Address - Country:US
Practice Address - Phone:660-826-1733
Practice Address - Fax:660-826-1733
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0146931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice