Provider Demographics
NPI:1952436883
Name:SIMPSON DENTAL OFFICES
Entity Type:Organization
Organization Name:SIMPSON DENTAL OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-785-0310
Mailing Address - Street 1:PO BOX 869
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-0869
Mailing Address - Country:US
Mailing Address - Phone:208-785-0310
Mailing Address - Fax:208-785-0319
Practice Address - Street 1:1180 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1651
Practice Address - Country:US
Practice Address - Phone:208-785-0310
Practice Address - Fax:208-785-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD13941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID43890OtherBLUE CROSS