Provider Demographics
NPI:1851709463
Name:MICHAEL R SIMPSON DMD, PA
Entity Type:Organization
Organization Name:MICHAEL R SIMPSON DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RYON
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-977-6464
Mailing Address - Street 1:1445 E MITCHELL HAMMOCK RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9144
Mailing Address - Country:US
Mailing Address - Phone:407-977-6464
Mailing Address - Fax:407-977-9989
Practice Address - Street 1:1445 E MITCHELL HAMMOCK RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9144
Practice Address - Country:US
Practice Address - Phone:407-977-6464
Practice Address - Fax:407-977-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14132261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental