Individual
DR. OCTAVIA S SIMKINS-WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
12150 ANNAPOLIS RD, SUITE301, GLENN DALE, MD 20769-9183
(301) 249-8000
(301) 249-4958
Mailing address
12150 ANNAPOLIS RD, SUITE301, GLENN DALE, MD 20769-9183
(301) 249-8000
(301) 249-4958
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10983
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10983
STATE LICENSE
MD
Enumeration date
04/18/2007
Last updated
03/12/2013
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