Provider Demographics
NPI:1134103526
Name:SIMS, ARNOLD R (DDS)
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:R
Last Name:SIMS
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 1:208 FRONT ST N
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3232
Mailing Address - Country:US
Mailing Address - Phone:425-392-5323
Mailing Address - Fax:425-313-1080
Practice Address - Street 1:208 FRONT ST N
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3232
Practice Address - Country:US
Practice Address - Phone:425-392-5323
Practice Address - Fax:425-313-1080
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3033OtherWASHINGTON DENTAL
WA484232OtherUNITED HEALTHCARE ID
WA5303300Medicaid