MEDICARE: JACQUELINE H SIMONS 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	044911	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1396934022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE H SIMONS DDS

Provider Business Mailing Address
First Line	:	2812 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-2229
Country	:	US
Telephone Number	:	516-536-5340
Fax Number	:	516-536-5383

Provider Business Practice Location Address
First Line	:	2812 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-2229
Country	:	US
Telephone Number	:	516-536-5340
Fax Number	:	516-536-5383

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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