Healthcare Provider Details

I. General information

NPI: 1770533531
Provider Name (Legal Business Name): NICHOLAS H. PSIMOS, DDS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N BROADWAY
ROCHESTER MN
55906-6841
US

IV. Provider business mailing address

1101 N BROADWAY
ROCHESTER MN
55906-6841
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-0126
  • Fax: 507-529-0810
Mailing address:
  • Phone: 507-288-0126
  • Fax: 507-529-0810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS H. PSIMOS
Title or Position: OWNER
Credential: D.D.S.
Phone: 507-288-0126