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General NPI Number Information
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NPI Number | 1891874525
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Entity Type | Organization
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Legal Business Name | SIMON & SIMON DDS
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2840 DELAWARE AVENUE 2ND FLOOR
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City | KENMORE
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State | NY
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Zip | 14217
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Country | US
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Telephone | 716-875-4295
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Fax | 716-876-8237
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Provider Business Mailing Address
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Address Line | 2840 DELAWARE AVENUE 2ND FLOOR
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City | KENMORE
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State | NY
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Zip | 14217
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Country | US
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Telephone | 716-875-4295
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Fax | 716-876-8237
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Authorized Official
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Title or Position | DENTIST PARTNER
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Name | CAROL ANN SIMON
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Credential | DDS
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Telephone | 716-875-4295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 041811
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 20083
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License Number State | NY
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