Provider Demographics
NPI:1871647214
Name:SIMS, FRED MARKEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:MARKEL
Last Name:SIMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4004
Mailing Address - Country:US
Mailing Address - Phone:502-499-9494
Mailing Address - Fax:502-499-9696
Practice Address - Street 1:4600 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4004
Practice Address - Country:US
Practice Address - Phone:502-499-9494
Practice Address - Fax:502-499-9696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice