MEDICARE: DR. RAYMOND KENT SIMISTER 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	1223G0001X	General Practice Dentistry	692	NV

General Provider Information

NPI Number	:	1760423164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND KENT SIMISTER D.M.D.

Provider Business Mailing Address
First Line	:	4610 MEADOWS LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2965
Country	:	US
Telephone Number	:	702-878-7700
Fax Number	:	702-878-4630

Provider Business Practice Location Address
First Line	:	4610 MEADOWS LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2965
Country	:	US
Telephone Number	:	702-878-7700
Fax Number	:	702-878-4630

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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