Organization
NICHOLAS H. PSIMOS, DDS, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS H. PSIMOS D.D.S. (OWNER)
(507) 288-0126
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088575
—
IA
01
—
08865
BCBS IA
IA
01
—
1B261PS
BCBS MN
MN
05
—
324222600
—
MN
Enumeration date
05/11/2006
Last updated
05/17/2011
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