Provider Demographics
NPI:1144638602
Name:PENSACOLA KIDS DENTISTRY
Entity type:Organization
Organization Name:PENSACOLA KIDS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-698-3304
Mailing Address - Street 1:4541 N DAVIS HWY
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2783
Mailing Address - Country:US
Mailing Address - Phone:850-549-3656
Mailing Address - Fax:
Practice Address - Street 1:4541 N DAVIS HWY
Practice Address - Street 2:SUITE 6B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2783
Practice Address - Country:US
Practice Address - Phone:850-549-3656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19981261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental