1093746539 NPI number — JOHN CARL SIMKEVICH DMD

Table of content: SONAM DODHIA MD (NPI 1285130302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093746539 NPI number — JOHN CARL SIMKEVICH DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMKEVICH
Provider First Name:
JOHN
Provider Middle Name:
CARL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093746539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
990 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST GREENWICH
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02818-3187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-885-8575
Provider Business Mailing Address Fax Number:
401-885-8577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST GREENWICH
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02818-3187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-885-8575
Provider Business Practice Location Address Fax Number:
401-885-8577
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  1655 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 145484 . This is a "UNITED HEALTH SENIOR-PAWT" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 5657159 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 8447-5 . This is a "BLUE CROSS-COV" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 3068099 . This is a "AETNA HMO EG" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 3068101 . This is a "AETNA HMO- COV" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2001655 . This is a "DELTA DENTAL -PAWT" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 5001655 . This is a "DELTA DENTAL-COV" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 8000056 . This is a "UNITED HEALTH-EG" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 8356-2 . This is a "BLUE CROSS-PAWT" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 8442-0 . This is a "BLUE CROSS-EG" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 145483 . This is a "UNITED SENIOR-EG" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 8000057 . This is a "UNITED HEALTH-COV" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 8000075 . This is a "UNITED HEALTH-PAWT" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 3068102 . This is a "AETNA-HMO" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4001655 . This is a "DELTA DENTAL -EG" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 145482 . This is a "UNITED SENIOR-COV" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 201298 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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