MEDICARE: DR. DAVID A. SIMON DDS

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	1223G0001X	General Practice Dentistry	4653	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	834525	OTHER	OK	UNITED CONCORDIA
2	765292	OTHER	OK	UCCI PROVIDER #

General Provider Information

NPI Number	:	1144222027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A. SIMON DDS

Provider Business Mailing Address
First Line	:	8001 N MACARTHUR BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-4714
Country	:	US
Telephone Number	:	405-728-7171
Fax Number	:	405-720-1997

Provider Business Practice Location Address
First Line	:	8001 N MACARTHUR BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-4714
Country	:	US
Telephone Number	:	405-728-7171
Fax Number	:	405-720-1997

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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