Provider Demographics
NPI:1679615744
Name:SIMMS, PHILIP BENSON (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:BENSON
Last Name:SIMMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:PHIL
Other - Middle Name:B
Other - Last Name:SIMMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:405 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-3412
Mailing Address - Country:US
Mailing Address - Phone:205-755-1960
Mailing Address - Fax:205-755-1960
Practice Address - Street 1:405 2ND AVE N
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-3412
Practice Address - Country:US
Practice Address - Phone:205-755-1960
Practice Address - Fax:205-755-1960
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist