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NPI Code Detail

MEDICARE: DR. DAMAN P SIMANTIRIS D.M.D.

MEDICARE: DR. DAMAN P SIMANTIRIS D.M.D.
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
11223G0001XGeneral Practice Dentistry23705OH
2122300000XDentist23705OH

General Provider Information

NPI Number : 1619238854
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAMAN P SIMANTIRIS D.M.D.
Provider Business Mailing Address
First Line : 2500 CLARK AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1111
Country : US
Telephone Number : 216-860-1195
Fax Number :
Provider Business Practice Location Address
First Line : 2500 CLARK AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1111
Country : US
Telephone Number : 216-860-1195
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2012
Last Update Date : 04/19/2017

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