Healthcare Provider Details

I. General information

NPI: 1821844689
Provider Name (Legal Business Name): SIMPLY SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 SE CEDARWOOD DR
GRIMES IA
50111-1143
US

IV. Provider business mailing address

348 SE CEDARWOOD DR
GRIMES IA
50111-1143
US

V. Phone/Fax

Practice location:
  • Phone: 515-360-0393
  • Fax:
Mailing address:
  • Phone: 515-360-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMANDA GODFREY
Title or Position: OWNER
Credential:
Phone: 515-360-0393