Provider Demographics
NPI:1306997465
Name:SIMONS, CHARLES MORRIS (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MORRIS
Last Name:SIMONS
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
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Mailing Address - Street 1:3415 S LAFOUNTAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902
Mailing Address - Country:US
Mailing Address - Phone:765-453-2300
Mailing Address - Fax:765-453-3348
Practice Address - Street 1:3415 S LAFOUNTAIN ST
Practice Address - Street 2:STE A
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902
Practice Address - Country:US
Practice Address - Phone:765-453-2300
Practice Address - Fax:765-453-3348
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006533A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics