Provider Demographics
NPI:1396828760
Name:SIMS, CHARLES WESLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WESLEY
Last Name:SIMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 LYDIA DR W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1923
Mailing Address - Country:US
Mailing Address - Phone:651-766-8260
Mailing Address - Fax:612-825-3819
Practice Address - Street 1:17 E 38TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1341
Practice Address - Country:US
Practice Address - Phone:612-825-7835
Practice Address - Fax:612-825-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice