Healthcare Provider Details

I. General information

NPI: 1962571018
Provider Name (Legal Business Name): DR DENIS E SIMON III, DR MICHAEL SCOTT BOND AND GWENDOLYN DENISE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9804 BLUEBONNET BLVD SUITE B
BATON ROUGE LA
70810-6442
US

IV. Provider business mailing address

9804 BLUEBONNET BLVD SUITE B
BATON ROUGE LA
70810-6442
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-3061
  • Fax: 225-766-3199
Mailing address:
  • Phone: 225-766-3061
  • Fax: 225-766-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2873
License Number StateLA

VIII. Authorized Official

Name: DR. DENIS E SIMON III
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 225-766-3061