Provider Demographics
NPI:1285630707
Name:CHARLES H. SIMPSON III, D.D.S., P.A.
Entity Type:Organization
Organization Name:CHARLES H. SIMPSON III, D.D.S., P.A.
Other - Org Name:RENAISSANCE DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-363-8444
Mailing Address - Street 1:800 W WILLIAMS ST
Mailing Address - Street 2:STE 240
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5204
Mailing Address - Country:US
Mailing Address - Phone:919-363-8444
Mailing Address - Fax:919-363-6391
Practice Address - Street 1:800 W WILLIAMS ST
Practice Address - Street 2:STE 240
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5204
Practice Address - Country:US
Practice Address - Phone:919-363-8444
Practice Address - Fax:919-363-6391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899014JMedicaid