Provider Demographics
NPI:1922120872
Name:SIMS, DAVID DELANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DELANE
Last Name:SIMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 NEW YORK AVENUE
Mailing Address - Street 2:SUITE 2W
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2743
Mailing Address - Country:US
Mailing Address - Phone:631-549-4055
Mailing Address - Fax:631-549-1035
Practice Address - Street 1:120 NEW YORK AVENUE
Practice Address - Street 2:SUITE 2W
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2743
Practice Address - Country:US
Practice Address - Phone:631-549-4055
Practice Address - Fax:631-549-1035
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6692530001Medicare NSC