Healthcare Provider Details

I. General information

NPI: 1649949801
Provider Name (Legal Business Name): JOHN JEFFREY SIMINDINGER DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 LINDEN AVE
DAYTON OH
45432-3031
US

IV. Provider business mailing address

2580 SLABTOWN RD
LIMA OH
45801-2204
US

V. Phone/Fax

Practice location:
  • Phone: 937-252-8651
  • Fax:
Mailing address:
  • Phone: 419-230-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30.026648
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: