Provider Demographics
NPI:1649406760
Name:CLETUS HELMS SIMPSON, DDS PA
Entity Type:Organization
Organization Name:CLETUS HELMS SIMPSON, DDS PA
Other - Org Name:BUNN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLETUS
Authorized Official - Middle Name:HELMS
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-971-5324
Mailing Address - Street 1:23 NC 98 HWY E
Mailing Address - Street 2:STE 200
Mailing Address - City:BUNN
Mailing Address - State:NC
Mailing Address - Zip Code:27508-7291
Mailing Address - Country:US
Mailing Address - Phone:919-971-5324
Mailing Address - Fax:
Practice Address - Street 1:23 NC 98 HWY E
Practice Address - Street 2:STE 200
Practice Address - City:BUNN
Practice Address - State:NC
Practice Address - Zip Code:27508-7291
Practice Address - Country:US
Practice Address - Phone:919-971-5324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty