Individual
DR. NICHOLAS H. PSIMOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S, PLC
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D10595
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0088575
—
IA
01
—
1B261PS
BCBS PROVIDER ID
MN
05
—
324222600
—
MN
Enumeration date
02/28/2006
Last updated
04/21/2011
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