Healthcare Provider Details

I. General information

NPI: 1184640179
Provider Name (Legal Business Name): DARRELL B. SIMS D.D.S., P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 N 7TH STREET
PHOENIX AZ
85004
US

IV. Provider business mailing address

2202 N 7TH STREET
PHOENIX AZ
85004
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-7563
  • Fax: 602-266-6349
Mailing address:
  • Phone: 602-230-7563
  • Fax: 602-266-6349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3778
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: