Provider Demographics
NPI:1427054998
Name:SIMITIS, RICHARD P (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:SIMITIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:P
Other - Last Name:SIMITIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:41 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2730
Mailing Address - Country:US
Mailing Address - Phone:508-791-0943
Mailing Address - Fax:508-792-0366
Practice Address - Street 1:41 OAK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2730
Practice Address - Country:US
Practice Address - Phone:508-791-0943
Practice Address - Fax:508-792-0366
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX04560OtherBCBS PROVIDER#FOR INS