Provider Demographics
NPI:1508945734
Name:SIMPSON, PATRICK S (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:S
Last Name:SIMPSON
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 1:410 BLANDING BLVD
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5051
Mailing Address - Country:US
Mailing Address - Phone:904-276-5950
Mailing Address - Fax:904-276-5359
Practice Address - Street 1:410 BLANDING BLVD
Practice Address - Street 2:SUITE 6B
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5051
Practice Address - Country:US
Practice Address - Phone:904-276-5950
Practice Address - Fax:904-276-5359
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0012405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist