Organization
SIMPSON DENTAL OFFICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES GORDON SIMPSON DDS (V PRESIDENT DENTIST)
(208) 785-0310
Entity
Organization
Contact information
Practice address
1180 PARKWAY DR, BLACKFOOT, ID 83221-1651
(208) 785-0310
(208) 785-0319
Mailing address
PO BOX 869, BLACKFOOT, ID 83221-0869
(208) 785-0310
(208) 785-0319
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1394
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43890
BLUE CROSS
ID
Enumeration date
02/22/2007
Last updated
08/22/2020
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