Provider Demographics
NPI:1548553134
Name:DORIUS & SIMMONS, PLLC
Entity type:Organization
Organization Name:DORIUS & SIMMONS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:DORIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-668-1642
Mailing Address - Street 1:929 W SUNSET BLVD
Mailing Address - Street 2:#15
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 B ST
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-1768
Practice Address - Country:US
Practice Address - Phone:509-235-6137
Practice Address - Fax:509-235-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60178011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty