Provider Demographics
NPI:1356775316
Name:DANIELLE L SIM DMD PC
Entity type:Organization
Organization Name:DANIELLE L SIM DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-710-1893
Mailing Address - Street 1:3901 MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5435
Mailing Address - Country:US
Mailing Address - Phone:718-710-1893
Mailing Address - Fax:
Practice Address - Street 1:3901 MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5435
Practice Address - Country:US
Practice Address - Phone:718-710-1893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03161864Medicaid