Provider Demographics
NPI:1568551976
Name:SIM, SAMUEL H (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:H
Last Name:SIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1151 CORNWALL RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7233
Mailing Address - Country:US
Mailing Address - Phone:717-273-4764
Mailing Address - Fax:717-273-3419
Practice Address - Street 1:1151 CORNWALL RD
Practice Address - Street 2:SUITE #3
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7233
Practice Address - Country:US
Practice Address - Phone:717-273-4764
Practice Address - Fax:717-273-3419
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026513L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice