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General NPI Number Information
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NPI Number | 1407473481
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Entity Type | Organization
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Legal Business Name | SIMON FAMILY DENTISTRY
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 191 HIGHWAY 64 E
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City | ALMA
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State | AR
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Zip | 72921-3306
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Country | US
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Telephone | 479-430-7049
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Fax | 479-430-7051
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Provider Business Mailing Address
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Address Line | PO BOX 150
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City | ALMA
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State | AR
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Zip | 72921-0150
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Country | US
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Telephone | 479-430-7049
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Fax | 479-430-7051
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JEREMY SIMON
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Credential | DDS
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Telephone | 479-430-7049
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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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