Individual
DR. NICHOLAS H. PSIMOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S, PLC
Contact information
Practice address
1101 N BROADWAY, ROCHESTER, MN 55906-6841
(507) 288-0126
(507) 529-0810
Mailing address
1101 N BROADWAY, ROCHESTER, MN 55906-6841
(507) 288-0126
(507) 529-0810
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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