MEDICARE: DR. SIMON R. PRIOR DDS, PHD

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	1223D0004X	Dental Anesthesiology	71-000179	OH
2	207L00000X	Anesthesiology Physician	71-000179	OH
3	122300000X	Dentist	0179	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215084157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON R. PRIOR DDS, PHD

Provider Business Mailing Address
First Line	:	305 W 12TH AVE
Second Line	:	2148, POSTLE HALL
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-247-8014
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 W 12TH AVE
Second Line	:	DENTAL FACULTY PRACTICE ASSOCIATION
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-247-0002
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	05/21/2013

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