Provider Demographics
NPI:1487159331
Name:TOTAL CARE DENTAL PLLC
Entity type:Organization
Organization Name:TOTAL CARE DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:FM
Authorized Official - Last Name:SIMPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-581-0081
Mailing Address - Street 1:3911 W 27TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-2483
Mailing Address - Country:US
Mailing Address - Phone:509-581-0081
Mailing Address - Fax:509-591-9888
Practice Address - Street 1:3911 W 27TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-2483
Practice Address - Country:US
Practice Address - Phone:509-581-0081
Practice Address - Fax:509-591-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60023578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty