MEDICARE: VINCENT A 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
1	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1255534111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT A SIMONE DDS

Provider Business Mailing Address
First Line	:	4747 N HARLEM AVE
Second Line	:	SUITE D
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4652
Country	:	US
Telephone Number	:	708-867-4700
Fax Number	:	708-867-8107

Provider Business Practice Location Address
First Line	:	4747 N HARLEM AVE
Second Line	:	SUITE D
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4652
Country	:	US
Telephone Number	:	708-867-4700
Fax Number	:	708-867-8107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	03/07/2023

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