MEDICARE: DR. JEFFREY R. SIMISTER D.D.S., M.S.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	354748	UT
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2989	NV

General Provider Information

NPI Number	:	1386746394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY R. SIMISTER D.D.S., M.S.D.

Provider Business Mailing Address
First Line	:	1054 E RIVERSIDE DR
Second Line	:	SUITE #101
City	:	ST GEORGE
State	:	UT
Zip	:	84790-4477
Country	:	US
Telephone Number	:	435-656-3346
Fax Number	:	435-656-9058

Provider Business Practice Location Address
First Line	:	1054 E RIVERSIDE DR
Second Line	:	SUITE #101
City	:	ST GEORGE
State	:	UT
Zip	:	84790-4477
Country	:	US
Telephone Number	:	435-656-3346
Fax Number	:	435-656-9058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2007

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