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General NPI Number Information
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NPI Number | 1265240345
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Entity Type | Organization
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Legal Business Name | LAURA C SIMON DMD
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 363 PLEASANT ST
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City | BELMONT
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State | MA
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Zip | 02478-3245
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Country | US
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Telephone | 617-484-2245
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Fax |
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Provider Business Mailing Address
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Address Line | 101 BEDFORD ST
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City | LEXINGTON
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State | MA
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Zip | 02420-4301
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Country | US
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Telephone | 617-530-0258
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAURA C SIMON
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Credential | DMD
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Telephone | 617-530-0258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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