Provider Demographics
NPI:1275359655
Name:SIMPLY SMILE P.S.C.
Entity type:Organization
Organization Name:SIMPLY SMILE P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:MOUA
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:404-313-0944
Mailing Address - Street 1:2677 MOUNDS VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNDS VIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:404-313-0944
Mailing Address - Fax:
Practice Address - Street 1:2677 MOUNDS VIEW BLVD
Practice Address - Street 2:
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112-5511
Practice Address - Country:US
Practice Address - Phone:404-313-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty