Provider Demographics
NPI:1043334550
Name:SIMUNDS, JOHN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:SIMUNDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10056 SE 240TH ST
Mailing Address - Street 2:#C
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5126
Mailing Address - Country:US
Mailing Address - Phone:253-852-4272
Mailing Address - Fax:253-852-7583
Practice Address - Street 1:10056 SE 240TH ST
Practice Address - Street 2:#C
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5126
Practice Address - Country:US
Practice Address - Phone:253-852-4272
Practice Address - Fax:253-852-7583
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA41311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4131OtherWA. STATE DENTAL LICENSE