Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 11388 | TX |
NPI | 1063744050 |
---|---|
Provider Name | Harold Von Simpson |
First Address | Richardson, TX 75080-5332 |
Second Address | Richardson, TX 75080-5332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2010 |
Last Update Date | 02/02/2010 |