| NPI | 1902983067 |
|---|---|
| Former Legal Business Name | D SIM SICELOFF III DDS |
| Entity Type | Organization |
| Authorized Contact | DAVID SIMEON SICELOFF President 336-249-6524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-04-08 |