Healthcare Provider Details

I. General information

NPI: 1588645006
Provider Name (Legal Business Name): CLETUS H. SIMPSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 MAIN STREET
BUNN NC
27508
US

IV. Provider business mailing address

PO BOX 338
BUNN NC
27508
US

V. Phone/Fax

Practice location:
  • Phone: 919-729-1103
  • Fax: 919-729-1105
Mailing address:
  • Phone: 919-729-1103
  • Fax: 919-729-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8031
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8031
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8031
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: