Provider Demographics
NPI:1922388594
Name:SIMS, KASTAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KASTAN
Middle Name:
Last Name:SIMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4525
Mailing Address - Country:US
Mailing Address - Phone:901-725-7132
Mailing Address - Fax:901-725-0264
Practice Address - Street 1:1279 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4525
Practice Address - Country:US
Practice Address - Phone:901-725-7132
Practice Address - Fax:901-725-0264
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000009237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist