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NPI Code Detail

MEDICARE: DR. BRYAN J SIMONE DDS

MEDICARE: DR. BRYAN J SIMONE DDS
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
1122300000XDentist19692OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154543296
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRYAN J SIMONE DDS
Provider Business Mailing Address
First Line : 4178 HOOVER RD
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-3625
Country : US
Telephone Number : 614-875-3141
Fax Number : 614-875-8812
Provider Business Practice Location Address
First Line : 4178 HOOVER RD
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-3625
Country : US
Telephone Number : 614-875-3141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 09/20/2019

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