Provider Demographics
NPI:1285610329
Name:SIM, DANIELLE LEAH (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LEAH
Last Name:SIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 AVALON CIR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3871
Mailing Address - Country:US
Mailing Address - Phone:718-710-1893
Mailing Address - Fax:
Practice Address - Street 1:149 AVALON CIR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3871
Practice Address - Country:US
Practice Address - Phone:718-710-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035827122300000X
NY054654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist