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Individual

DR. CHARLES GORDON SIMPSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1180 PARKWAY DR, BLACKFOOT, ID 83221-0869
(208) 785-0310
(208) 785-0319
Mailing address
1180 PARKWAY DR, PO BOX 869, BLACKFOOT, ID 83221-0869
(208) 785-0310
(208) 785-0319

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1394
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
162787
UNITA CONCORDIA INS
Enumeration date
02/16/2007
Last updated
07/08/2007
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