Healthcare Provider Details

I. General information

NPI: 1205746997
Provider Name (Legal Business Name): SOPHIA SIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 E LINCOLN HWY
CROWN POINT IN
46307-8824
US

IV. Provider business mailing address

8000 E LINCOLN HWY
CROWN POINT IN
46307-8824
US

V. Phone/Fax

Practice location:
  • Phone: 219-356-8000
  • Fax: 219-245-0177
Mailing address:
  • Phone: 219-356-8000
  • Fax: 219-245-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12015141A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: