Provider Demographics
NPI:1144622747
Name:SIMPSON, JELENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JELENA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JELENA
Other - Middle Name:
Other - Last Name:VUCIJAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:22 MILL ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4738
Mailing Address - Country:US
Mailing Address - Phone:781-648-0279
Mailing Address - Fax:
Practice Address - Street 1:22 MILL ST STE 104
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4738
Practice Address - Country:US
Practice Address - Phone:781-648-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30215122300000X
MADN1857836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist