Healthcare Provider Details

I. General information

NPI: 1063809101
Provider Name (Legal Business Name): CORNELIU SIMA DMD MSC DSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10443 DOUBLE R BLVD
RENO NV
89521-8905
US

IV. Provider business mailing address

1851 STEAMBOAT PKWY UNIT 12432
RENO NV
89521-6386
US

V. Phone/Fax

Practice location:
  • Phone: 775-521-5955
  • Fax:
Mailing address:
  • Phone: 857-292-2284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDF11069
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS4-124C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: