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NPI Code Detail

MEDICARE: SIMONE FAVOR DDS LLC

MEDICARE: SIMONE FAVOR DDS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1144020058
Entity Type Code : Organization
Provider Name (Legal Business Name) : SIMONE FAVOR DDS LLC
Provider Business Mailing Address
First Line : PO BOX 70887
Second Line :
City : CLEVELAND
State : OH
Zip : 44190-0887
Country : US
Telephone Number : 315-454-6000
Fax Number : 315-410-5531
Provider Business Practice Location Address
First Line : 4016 LEMAY FERRY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-1858
Country : US
Telephone Number : 314-627-0209
Fax Number : 314-894-5534
Authorized Official
Title or Position : PROVIDER ENROLLMENT
Name : CHRISTINE BARBER
Credential :
Telephone Number : 315-454-6000
Provider Enumeration Date : 03/18/2025
Last Update Date : 03/18/2025

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Directions to “SIMONE FAVOR DDS LLC ” Practice Location

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