Provider Demographics
NPI:1033254008
Name:SIMS, JOHN JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:SIMS
Suffix:
Gender:M
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:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:EDDYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42038-0530
Mailing Address - Country:US
Mailing Address - Phone:270-388-9712
Mailing Address - Fax:270-388-9713
Practice Address - Street 1:260 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:EDDYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42038-8294
Practice Address - Country:US
Practice Address - Phone:270-388-9712
Practice Address - Fax:270-388-9713
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48671223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45003589Medicaid
KY60048675Medicaid