Provider Demographics
NPI:1336740216
Name:SIMPSON, THOMAS ROBERT MATTHEW
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROBERT MATTHEW
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 KIRSTEN CT
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-4905
Mailing Address - Country:US
Mailing Address - Phone:530-840-4028
Mailing Address - Fax:
Practice Address - Street 1:1387 KIRSTEN CT
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4905
Practice Address - Country:US
Practice Address - Phone:530-840-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY68093321223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health