Provider Demographics
NPI:1861671638
Name:DR. MICHAEL J SIMS D.M.D. PC
Entity type:Organization
Organization Name:DR. MICHAEL J SIMS D.M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOESPH
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:757-427-0695
Mailing Address - Street 1:2109 MCCOMAS WAY
Mailing Address - Street 2:ST 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3909
Mailing Address - Country:US
Mailing Address - Phone:757-427-0695
Mailing Address - Fax:757-430-9341
Practice Address - Street 1:2109 MCCOMAS WAY
Practice Address - Street 2:ST 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3909
Practice Address - Country:US
Practice Address - Phone:757-427-0695
Practice Address - Fax:757-430-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty