Healthcare Provider Details

I. General information

NPI: 1891774162
Provider Name (Legal Business Name): THOMAS HERBERT SIMPSON JR. DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 S HERLONG AVE
ROCK HILL SC
29732
US

IV. Provider business mailing address

372 S HERLONG AVE
ROCK HILL SC
29732
US

V. Phone/Fax

Practice location:
  • Phone: 803-324-1160
  • Fax: 803-324-2456
Mailing address:
  • Phone: 803-324-1160
  • Fax: 803-324-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberSC2826
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: