Provider Demographics
NPI:1770608366
Name:SIMPSON, GERALD ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ALAN
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3528
Mailing Address - Country:US
Mailing Address - Phone:765-662-2224
Mailing Address - Fax:765-662-2304
Practice Address - Street 1:306 S BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3528
Practice Address - Country:US
Practice Address - Phone:765-662-2224
Practice Address - Fax:765-662-2304
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice