Provider Demographics
NPI:1598822744
Name:SIMPSON, JUANITA RUTH (RDH)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:RUTH
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 NE TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1349
Mailing Address - Country:US
Mailing Address - Phone:541-416-0471
Mailing Address - Fax:
Practice Address - Street 1:1270 KOT-NUM ROAD
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:OR
Practice Address - Zip Code:97761
Practice Address - Country:US
Practice Address - Phone:541-553-2462
Practice Address - Fax:541-553-2619
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3463124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist