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General NPI Number Information
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NPI Number | 1053558601
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Entity Type | Organization
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Legal Business Name | WM. L. SIMKO & GEORGE HARITONOVICH DDS INC.
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Dates
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Enumeration Date | 01/18/2009
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Last Update Date | 01/18/2009
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Provider Practice Location Address
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Address Line | 26777 LORAIN RD #417
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3200
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Country | US
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Telephone | 440-779-7292
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Fax | 440-779-0552
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Provider Business Mailing Address
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Address Line | 26777 LORAIN RD #417
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3200
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Country | US
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Telephone | 440-779-7292
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Fax | 440-779-0552
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Authorized Official
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Title or Position | DENTIST / VICE PRESIDENT
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Name | DR. GEORGE HARITONOVICH
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Credential | DDS
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Telephone | 440-779-7292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 13759
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18653
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License Number State | OH
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