Healthcare Provider Details

I. General information

NPI: 1033254008
Provider Name (Legal Business Name): JOHN JOSEPH SIMS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 COMMERCE ST
EDDYVILLE KY
42038-8294
US

IV. Provider business mailing address

PO BOX 530
EDDYVILLE KY
42038-0530
US

V. Phone/Fax

Practice location:
  • Phone: 270-388-9712
  • Fax: 270-388-9713
Mailing address:
  • Phone: 270-388-9712
  • Fax: 270-388-9713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4867
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4867
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: