Provider Demographics
NPI:1972993541
Name:KIMBERLY D SIMONDS DDS PC
Entity type:Organization
Organization Name:KIMBERLY D SIMONDS DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SIMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-227-2552
Mailing Address - Street 1:14738 MANCHESTER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3706
Mailing Address - Country:US
Mailing Address - Phone:636-227-2552
Mailing Address - Fax:
Practice Address - Street 1:14738 MANCHESTER RD
Practice Address - Street 2:SUITE B
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3706
Practice Address - Country:US
Practice Address - Phone:636-227-2552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO016003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty