Ervin Simmons IV DMD LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

13607 Issued in MO

Legal business name

ERVIN SIMMONS IV DMD LLC

Practice address

3220 Parker Rd
Florissant, MO 63033-3733

Phone

(314) 837-3232

Fax

(314) 837-3260

NPI assigned

Jan 19, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ervin Simmons IV, DMD

Title

Owner

Phone

(314) 837-3232

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484784000000",
    "number": "1780120410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 PARKER RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630333733",
            "telephone_number": "314-837-3232",
            "fax_number": "314-837-3260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 PARKER RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630333733",
            "telephone_number": "314-837-3232",
            "fax_number": "314-837-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERVIN SIMMONS IV DMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-19",
        "last_updated": "2017-01-19",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "ERVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-837-3232",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "13607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Florissant, MO
• Providers in Florissant, MO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.