Healthcare Provider Details

I. General information

NPI: 1649406760
Provider Name (Legal Business Name): CLETUS HELMS SIMPSON, DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 NC 98 HWY E STE 200
BUNN NC
27508-7291
US

IV. Provider business mailing address

23 NC 98 HWY E STE 200
BUNN NC
27508-7291
US

V. Phone/Fax

Practice location:
  • Phone: 919-971-5324
  • Fax:
Mailing address:
  • Phone: 919-971-5324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8031
License Number StateNC

VIII. Authorized Official

Name: DR. CLETUS HELMS SIMPSON
Title or Position: DENTIST
Credential: D.D.S.
Phone: 919-971-5324