Healthcare Provider Details

I. General information

NPI: 1780718163
Provider Name (Legal Business Name): RICHARD JAMES SIMONEAUX DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 N 1ST AVE STE 150
TUCSON AZ
85718-5685
US

IV. Provider business mailing address

4566 N 1ST AVE STE 150
TUCSON AZ
85718-5685
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-4118
  • Fax: 520-742-0126
Mailing address:
  • Phone: 520-742-4118
  • Fax: 520-742-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2529
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: