Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 3245 | AR |
NPI | 1063527042 |
---|---|
Provider Name | Kirt Simmons |
First Address | Little Rock, AR 72202-3510 |
Second Address | Little Rock, AR 72202-3510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |