Provider Demographics
NPI:1003939810
Name:DANIEL WILLIAM SIMS PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DANIEL WILLIAM SIMS PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-990-7336
Mailing Address - Street 1:375 N STEPHANIE ST BLDG 6
Mailing Address - Street 2:SUITE 611
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-8771
Mailing Address - Country:US
Mailing Address - Phone:702-990-7336
Mailing Address - Fax:702-990-7340
Practice Address - Street 1:375 N STEPHANIE ST BLDG 6
Practice Address - Street 2:SUITE 611
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8771
Practice Address - Country:US
Practice Address - Phone:702-990-7336
Practice Address - Fax:702-990-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002202052Medicaid