Provider Demographics
NPI:1245327824
Name:KIMCHE, SIMON SCOTT (DDS)
Entity type:Individual
Prefix:MR
First Name:SIMON
Middle Name:SCOTT
Last Name:KIMCHE
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 1:1901 PROSPECTOR AVE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060
Mailing Address - Country:US
Mailing Address - Phone:435-645-8500
Mailing Address - Fax:435-645-8173
Practice Address - Street 1:1901 PROSPECTOR AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060
Practice Address - Country:US
Practice Address - Phone:435-645-8500
Practice Address - Fax:435-645-8173
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3716339921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist