Healthcare Provider Details

I. General information

NPI: 1407852908
Provider Name (Legal Business Name): CHARLES H SIMPSON III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W WILLIAMS ST STE 240
APEX NC
27502-5204
US

IV. Provider business mailing address

800 W WILLIAMS ST STE 240
APEX NC
27502-5204
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-8444
  • Fax: 919-363-6391
Mailing address:
  • Phone: 919-363-8444
  • Fax: 919-363-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7177
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier899014J
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: