Provider Demographics
NPI:1992847701
Name:HOWARD SIMS DENTAL FACILITY
Entity type:Organization
Organization Name:HOWARD SIMS DENTAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-631-1100
Mailing Address - Street 1:3546 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-5233
Mailing Address - Country:US
Mailing Address - Phone:318-631-1100
Mailing Address - Fax:318-631-1127
Practice Address - Street 1:3546 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-5233
Practice Address - Country:US
Practice Address - Phone:318-631-1100
Practice Address - Fax:318-631-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1880990Medicaid
LA=========OtherFEDERAL TAX ID NUMBER