Healthcare Provider Details

I. General information

NPI: 1295229011
Provider Name (Legal Business Name): SARAH E SIMPTKINS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH E JACKSON

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PRAIRIE DRIVE
EAST PRAIRIE MO
63845
US

IV. Provider business mailing address

111 PRAIRIE DRIVE
EAST PRAIRIE MO
63845-4403
US

V. Phone/Fax

Practice location:
  • Phone: 573-649-9311
  • Fax: 573-649-9331
Mailing address:
  • Phone: 573-649-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2015018514
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: