Provider Demographics
NPI:1922190727
Name:SIMS, BRUCE ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:SIMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:DORON
Other - Middle Name:
Other - Last Name:KEREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:71-06 110TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-263-0445
Mailing Address - Fax:718-261-8944
Practice Address - Street 1:71-06 110TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-263-0445
Practice Address - Fax:718-261-8944
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0378461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice