Healthcare Provider Details

I. General information

NPI: 1770420820
Provider Name (Legal Business Name): JEROME RANSON SIMPSON II MPH, BSDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MEE THEE-UH ROAD, FORT BIDWELL, CA 96112.
FORT BIDWELL CA
96112
US

IV. Provider business mailing address

PO BOX 247
FORT BIDWELL CA
96112-0247
US

V. Phone/Fax

Practice location:
  • Phone: 530-537-0093
  • Fax:
Mailing address:
  • Phone: 530-537-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7476
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: