Provider Demographics
NPI:1174151773
Name:SIMMONS, KIANNA MICHELLE-VERNAE (DMD)
Entity type:Individual
Prefix:DR
First Name:KIANNA
Middle Name:MICHELLE-VERNAE
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 1:2 SOUTHCOURT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PAGET
Mailing Address - State:PAGET
Mailing Address - Zip Code:99999
Mailing Address - Country:BM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 SOUTHCOURT AVENUE
Practice Address - Street 2:
Practice Address - City:PAGET
Practice Address - State:PAGET
Practice Address - Zip Code:99999
Practice Address - Country:BM
Practice Address - Phone:441-236-4477
Practice Address - Fax:441-236-8380
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037301122300000X
TNDS10961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist