Healthcare Provider Details

I. General information

NPI: 1376605386
Provider Name (Legal Business Name): RONALD WILLIAM SIMONSEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10441 VALLEY VIEW RD
MACEDONIA OH
44056-1746
US

IV. Provider business mailing address

33009 POPHAM LN
SOLON OH
44139-5770
US

V. Phone/Fax

Practice location:
  • Phone: 330-468-2634
  • Fax: 330-468-2637
Mailing address:
  • Phone: 440-248-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-019597
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: