Provider Demographics
NPI:1710339015
Name:SIMISON, TERESA (RDH, MS)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SIMISON
Suffix:
Gender:F
Credentials:RDH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LUSCOMBE LN
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2521
Mailing Address - Country:US
Mailing Address - Phone:443-907-7309
Mailing Address - Fax:
Practice Address - Street 1:31 LUSCOMBE LN
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2521
Practice Address - Country:US
Practice Address - Phone:443-907-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH88043124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist