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Provider Information for 1164648010

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Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. OCTAVIA S SIMKINS-WISEMAN DDS

Gender: FEMALE

Individual NPI: 1164648010

Calendar   Last Updated:  2013-03-12
  Certification Date: 

Details

Name Value
NPI 1164648010
Enumeration Date 2007-04-18
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 12150 ANNAPOLIS RD SUITE301
GLENN DALE, MD 20769-9183
United States

Phone: 301-249-8000 | Fax: 301-249-4958
View Map External Link
Primary Practice Address 12150 ANNAPOLIS RD SUITE301
GLENN DALE, MD 20769-9183
United States

Phone: 301-249-8000 | Fax: 301-249-4958
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other STATE LICENSE MD 10983
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice MD 10983