Provider Demographics
NPI:1386783983
Name:SIMON, JILL (DDS)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1644
Mailing Address - Country:US
Mailing Address - Phone:203-888-0811
Mailing Address - Fax:203-888-1870
Practice Address - Street 1:318 OXFORD RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1644
Practice Address - Country:US
Practice Address - Phone:203-888-0811
Practice Address - Fax:203-888-1870
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT57641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry