MEDICARE: DR. CLETUS H. SIMPSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8031	NC
2	1223P0221X	Pediatric Dentistry	8031	NC
3	122300000X	Dentist	8031	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	560794933	OTHER	NC	TAX ID #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588645006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLETUS H. SIMPSON DDS

Provider Business Mailing Address
First Line	:	PO BOX 338
Second Line	:
City	:	BUNN
State	:	NC
Zip	:	27508
Country	:	US
Telephone Number	:	919-729-1103
Fax Number	:	919-729-1105

Provider Business Practice Location Address
First Line	:	565 MAIN STREET
Second Line	:
City	:	BUNN
State	:	NC
Zip	:	27508
Country	:	US
Telephone Number	:	919-729-1103
Fax Number	:	919-729-1105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	01/26/2023

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