MEDICARE: DR. CHARLES R SIMPSON IV D.M.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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	22892	TX

General Provider Information

NPI Number	:	1639384605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES R SIMPSON IV D.M.D.

Provider Business Mailing Address
First Line	:	5757 WARREN PKWY
Second Line	:	SUITE 320
City	:	FRISCO
State	:	TX
Zip	:	75034-4274
Country	:	US
Telephone Number	:	214-618-3070
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 WARREN PKWY
Second Line	:	SUITE 320
City	:	FRISCO
State	:	TX
Zip	:	75034-4274
Country	:	US
Telephone Number	:	214-618-3070
Fax Number	:

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

Provider Enumeration Date	:	05/13/2007
Last Update Date	:	10/28/2014

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