Provider Demographics
NPI:1194019414
Name:SIMMONS, LAUREN TROUTMAN (DMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:TROUTMAN
Last Name:SIMMONS
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:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-0276
Mailing Address - Country:US
Mailing Address - Phone:270-827-5522
Mailing Address - Fax:270-827-8272
Practice Address - Street 1:700A BARRETT BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4931
Practice Address - Country:US
Practice Address - Phone:270-827-5522
Practice Address - Fax:270-827-8272
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice