Provider Demographics
NPI:1164866398
Name:SIMPSON DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:SIMPSON DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-372-8363
Mailing Address - Street 1:1827 SIMPSON HIGHWAY 149
Mailing Address - Street 2:STE C
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-3439
Mailing Address - Country:US
Mailing Address - Phone:601-847-2100
Mailing Address - Fax:601-847-3111
Practice Address - Street 1:1827 SIMPSON HIGHWAY 149
Practice Address - Street 2:STE C
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3439
Practice Address - Country:US
Practice Address - Phone:601-847-2100
Practice Address - Fax:601-847-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03338818Medicaid
MS00660119Medicaid