Provider Demographics
NPI:1780990184
Name:DR KENNETH M. SIMCKES DMD PC
Entity type:Organization
Organization Name:DR KENNETH M. SIMCKES DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SIMCKES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-354-1441
Mailing Address - Street 1:2 TAUBER TERRACE
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1645
Mailing Address - Country:US
Mailing Address - Phone:845-354-1441
Mailing Address - Fax:845-362-4660
Practice Address - Street 1:2 TAUBER TERRACE
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1645
Practice Address - Country:US
Practice Address - Phone:845-354-1441
Practice Address - Fax:845-362-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty