Healthcare Provider Details

I. General information

NPI: 1487760856
Provider Name (Legal Business Name): DAVID G. SIMON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10115 W FOREST HILL BLVD SUITE 301
WELLINGTON FL
33414-3105
US

IV. Provider business mailing address

10115 W FOREST HILL BLVD SUITE 301
WELLINGTON FL
33414-3105
US

V. Phone/Fax

Practice location:
  • Phone: 561-333-3055
  • Fax: 561-333-8177
Mailing address:
  • Phone: 561-333-3055
  • Fax: 561-333-8177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: