Provider Demographics
NPI:1386614246
Name:SIMPSON, KEITH WARREN (DMD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WARREN
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 HALEY BARBOUR PKWY
Mailing Address - Street 2:PO BOX 5666
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-4796
Mailing Address - Country:US
Mailing Address - Phone:662-751-4800
Mailing Address - Fax:
Practice Address - Street 1:2225 HALEY BARBOUR PKWY
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-4796
Practice Address - Country:US
Practice Address - Phone:662-751-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3209-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist