Healthcare Provider Details

I. General information

NPI: 1700073400
Provider Name (Legal Business Name): SIMON RAJAN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

326 NICHOLS ROAD
FITCHBURG MA
01420-1914
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-9700
  • Fax: 978-221-6728
Mailing address:
  • Phone: 978-878-8100
  • Fax: 978-878-8418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9600
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22307
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: