Provider Demographics
NPI:1497084057
Name:SIMS, KENDALL M (DDS)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:M
Last Name:SIMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 JO JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2870
Mailing Address - Country:US
Mailing Address - Phone:615-327-9944
Mailing Address - Fax:615-327-0730
Practice Address - Street 1:1829 JO JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2870
Practice Address - Country:US
Practice Address - Phone:615-327-9944
Practice Address - Fax:615-327-0730
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS90721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery