MEDICARE: ANNA SIMONIS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	051554	NY

General Provider Information

NPI Number	:	1134337942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA SIMONIS D.D.S.

Provider Business Mailing Address
First Line	:	345 MAIN ST
Second Line	:	APT 7F
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-3660
Country	:	US
Telephone Number	:	914-831-5975
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 LEXINGTON AVE
Second Line	:
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-2720
Country	:	US
Telephone Number	:	914-242-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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