Provider Demographics
NPI:1568495315
Name:SIMPSON, JR., JOSEPH MYLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MYLES
Last Name:SIMPSON, JR.
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:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-0412
Mailing Address - Country:US
Mailing Address - Phone:970-484-5880
Mailing Address - Fax:970-484-0966
Practice Address - Street 1:F E WARREN AIR FORCE BASE DENTAL CLINIC
Practice Address - Street 2:6900 ALDEN DRIVE
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82005
Practice Address - Country:US
Practice Address - Phone:307-773-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice