Healthcare Provider Details

I. General information

NPI: 1720374317
Provider Name (Legal Business Name): ELIZABETH VI SIMPSON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 BROOKRIDGE TRL
NASHVILLE TN
37211-4779
US

IV. Provider business mailing address

181 BROOKRIDGE TRL
NASHVILLE TN
37211-4779
US

V. Phone/Fax

Practice location:
  • Phone: 317-918-4306
  • Fax:
Mailing address:
  • Phone: 317-918-4306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12345678
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: