Provider Demographics
NPI:1306074232
Name:SIMONTON, BENJAMIN JON-SPOON (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JON-SPOON
Last Name:SIMONTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 NANTUCKETT STE. A
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3194
Mailing Address - Country:US
Mailing Address - Phone:419-517-2100
Mailing Address - Fax:419-517-2104
Practice Address - Street 1:4646 NANTUCKETT STE A
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3194
Practice Address - Country:US
Practice Address - Phone:419-517-2100
Practice Address - Fax:419-517-2104
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010200471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery