Provider Demographics
NPI:1184640179
Name:SIMS, DARRELL B (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:B
Last Name:SIMS
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004
Mailing Address - Country:US
Mailing Address - Phone:602-230-7563
Mailing Address - Fax:602-266-6349
Practice Address - Street 1:2202 N 7TH STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004
Practice Address - Country:US
Practice Address - Phone:602-230-7563
Practice Address - Fax:602-266-6349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ093039Medicaid
AZ860614805OtherTAX ID
AZ093039Medicaid