Provider Demographics
NPI:1467082495
Name:SIMPLY DENTISTRY, LLC
Entity Type:Organization
Organization Name:SIMPLY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:FORTUNE
Authorized Official - Last Name:SIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-780-5959
Mailing Address - Street 1:610 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4518
Mailing Address - Country:US
Mailing Address - Phone:972-780-5959
Mailing Address - Fax:972-780-5969
Practice Address - Street 1:610 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4518
Practice Address - Country:US
Practice Address - Phone:972-780-5959
Practice Address - Fax:972-780-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental