Healthcare Provider Details

I. General information

NPI: 1891104006
Provider Name (Legal Business Name): GRACE SIMCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4543 NEW FALLS RD
LEVITTOWN PA
19056-3004
US

IV. Provider business mailing address

4543 NEW FALLS RD
LEVITTOWN PA
19056-3004
US

V. Phone/Fax

Practice location:
  • Phone: 215-447-2237
  • Fax: 215-945-2502
Mailing address:
  • Phone: 510-283-4422
  • Fax: 215-945-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS040621
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: