Healthcare Provider Details

I. General information

NPI: 1215191564
Provider Name (Legal Business Name): LAWRENCE OLIVER SIMS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8613 ROSWELL RD SUITE 100
ATLANTA GA
30350-1896
US

IV. Provider business mailing address

7000 PEACHTREE DUNWOODY RD. BULIDING 12 SUITE 100
SANDY SPRINGS GA
30328
US

V. Phone/Fax

Practice location:
  • Phone: 770-998-8089
  • Fax: 678-669-1838
Mailing address:
  • Phone: 770-286-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8384
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number008384
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: