Healthcare Provider Details

I. General information

NPI: 1013131036
Provider Name (Legal Business Name): BALES & SIMPSON,D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MARKET ST SUITE 2A
SMITHFIELD NC
27577-3915
US

IV. Provider business mailing address

PO BOX 635
SMITHFIELD NC
27577-0635
US

V. Phone/Fax

Practice location:
  • Phone: 919-934-3409
  • Fax: 919-934-2128
Mailing address:
  • Phone: 919-934-3409
  • Fax: 919-934-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6000
License Number StateNC

VII. Legacy identifiers

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

# 1
Identifier90379
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBSNC
# 2
Identifier8990379
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDICAID

VIII. Authorized Official

Name: DR. WHITNEY K BALES
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 919-934-3409