Provider Demographics
NPI:1427127489
Name:SIMMONS, CLARENCE E (DDS)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:E
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 1:3500 NE RALPH POWELL RD STE B
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2378
Mailing Address - Country:US
Mailing Address - Phone:816-317-0130
Mailing Address - Fax:816-873-1099
Practice Address - Street 1:3500 NE RALPH POWELL RD STE B
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2378
Practice Address - Country:US
Practice Address - Phone:816-317-0130
Practice Address - Fax:816-873-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015874332B00000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies