Provider Demographics
NPI:1104816529
Name:SIMONSEN, DENNIS LOREN (DMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LOREN
Last Name:SIMONSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14125 SW FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2567
Mailing Address - Country:US
Mailing Address - Phone:503-646-3169
Mailing Address - Fax:503-646-1667
Practice Address - Street 1:14125 SW FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2567
Practice Address - Country:US
Practice Address - Phone:503-646-3169
Practice Address - Fax:503-646-1667
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice