Provider Demographics
NPI:1184138232
Name:SIMMONS, VANESSA RENEE (DENTAL ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:RENEE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:RENEE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302B BAKER ST
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-3662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302B BAKER ST
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:910-322-1993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant