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General NPI Number Information
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NPI Number | 1912150384
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Entity Type | Individual
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Provider Name | MARK SIMONS D.M.D.,M.S.D.
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Gender | Male
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 721 N 182ND ST STE 303
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City | SHORELINE
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State | WA
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Zip | 98133-4400
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Country | US
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Telephone | 206-542-7575
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Fax | 206-542-5552
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Provider Business Mailing Address
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Address Line | 721 N 182ND ST STE 303
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City | SHORELINE
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State | WA
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Zip | 98133-4400
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Country | US
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Telephone | 206-542-7575
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Fax | 206-542-5552
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3888
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License Number State | WA
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