Healthcare Provider Details

I. General information

NPI: 1427097963
Provider Name (Legal Business Name): JOHN ARTHUR SIMPSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 8TH ST
RUPERT ID
83350-1417
US

IV. Provider business mailing address

502 8TH ST
RUPERT ID
83350-1417
US

V. Phone/Fax

Practice location:
  • Phone: 208-436-4747
  • Fax: 208-436-9683
Mailing address:
  • Phone: 208-436-4747
  • Fax: 208-436-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD1885
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: