Healthcare Provider Details

I. General information

NPI: 1588281570
Provider Name (Legal Business Name): ASHLEY SIMONE SIMPSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BUJACICH RD NW
GIG HARBOR WA
98332-8300
US

IV. Provider business mailing address

3528 S ASOTIN ST
TACOMA WA
98418-2627
US

V. Phone/Fax

Practice location:
  • Phone: 360-407-5742
  • Fax:
Mailing address:
  • Phone: 509-669-9862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberRR60958429
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: