=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336740216
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS ROBERT MATTHEW SIMPSON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2020
-----------------------------------------------------
Last Update Date | 11/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1387 KIRSTEN CT
-----------------------------------------------------
City | RED BLUFF
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96080-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-840-4028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1387 KIRSTEN CT
-----------------------------------------------------
City | RED BLUFF
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96080-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-840-4028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223D0001X
-----------------------------------------------------
Taxonomy Name | Public Health Dentistry
-----------------------------------------------------
License Number | Y6809332
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------