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General NPI Number Information
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NPI Number | 1952436883
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Entity Type | Organization
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Legal Business Name | SIMPSON DENTAL OFFICES
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1180 PARKWAY DR
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City | BLACKFOOT
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State | ID
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Zip | 83221-1651
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Country | US
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Telephone | 208-785-0310
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Fax | 208-785-0319
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Provider Business Mailing Address
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Address Line | PO BOX 869
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City | BLACKFOOT
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State | ID
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Zip | 83221-0869
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Country | US
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Telephone | 208-785-0310
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Fax | 208-785-0319
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Authorized Official
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Title or Position | V PRESIDENT DENTIST
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Name | DR. CHARLES GORDON SIMPSON
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Credential | DDS
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Telephone | 208-785-0310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D1394
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License Number State | ID
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