Provider Demographics
NPI:1164570511
Name:SIMLEY II, DONALD OTIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:OTIS
Last Name:SIMLEY II
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 1:2037 WINNEBAGO ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5370
Mailing Address - Country:US
Mailing Address - Phone:608-249-6616
Mailing Address - Fax:608-249-9566
Practice Address - Street 1:2037 WINNEBAGO ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5370
Practice Address - Country:US
Practice Address - Phone:608-249-6616
Practice Address - Fax:608-249-9566
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50016271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice