MEDICARE: DORIUS & SIMMONS, PLLC

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	122300000X	Dentist	DE 60178011	WA

General Provider Information

NPI Number	:	1548553134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORIUS & SIMMONS, PLLC

Provider Business Mailing Address
First Line	:	929 W SUNSET BLVD
Second Line	:	#15
City	:	ST GEORGE
State	:	UT
Zip	:	84770-4865
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 B ST
Second Line	:
City	:	CHENEY
State	:	WA
Zip	:	99004-1768
Country	:	US
Telephone Number	:	509-235-6137
Fax Number	:	509-235-5689

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. KEVIN STANLEY DORIUS
Credential	:	DMD
Telephone Number	:	435-668-1642

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	05/16/2011

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