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General NPI Number Information
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NPI Number | 1790049047
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Entity Type | Individual
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Provider Name | EMILY P SIMON D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 1207 SHERWOOD PARK DR NE
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City | GAINESVILLE
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State | GA
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Zip | 30501-3444
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Country | US
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Telephone | 678-450-7011
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Fax | 678-971-4201
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Provider Business Mailing Address
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Address Line | 1207 SHERWOOD PARK DR NE
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City | GAINESVILLE
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State | GA
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Zip | 30501-3444
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Country | US
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Telephone | 678-450-7011
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Fax | 678-971-4201
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN014424
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License Number State | GA
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