Provider Demographics
NPI:1093746539
Name:SIMKEVICH, JOHN CARL (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CARL
Last Name:SIMKEVICH
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 1:990 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3187
Mailing Address - Country:US
Mailing Address - Phone:401-885-8575
Mailing Address - Fax:401-885-8577
Practice Address - Street 1:990 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3187
Practice Address - Country:US
Practice Address - Phone:401-885-8575
Practice Address - Fax:401-885-8577
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI16551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI145484OtherUNITED HEALTH SENIOR-PAWT
RI5657159OtherAETNA
RI8447-5OtherBLUE CROSS-COV
RI3068099OtherAETNA HMO EG
RI3068101OtherAETNA HMO- COV
RI2001655OtherDELTA DENTAL -PAWT
RI5001655OtherDELTA DENTAL-COV
RI8000056OtherUNITED HEALTH-EG
RI8356-2OtherBLUE CROSS-PAWT
RI8442-0OtherBLUE CROSS-EG
RI145483OtherUNITED SENIOR-EG
RI8000057OtherUNITED HEALTH-COV
RI8000075OtherUNITED HEALTH-PAWT
RI3068102OtherAETNA-HMO
RI4001655OtherDELTA DENTAL -EG
RI145482OtherUNITED SENIOR-COV
RI201298OtherBLUE CHIP
RI5001655OtherDELTA DENTAL-COV