Provider Demographics
NPI:1538163894
Name:SIMON, LESLIE N (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:N
Last Name:SIMON
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:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518-0273
Mailing Address - Country:US
Mailing Address - Phone:914-763-5892
Mailing Address - Fax:914-763-8693
Practice Address - Street 1:787 ROUTE 35
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518-1109
Practice Address - Country:US
Practice Address - Phone:914-763-5892
Practice Address - Fax:914-763-8693
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0277611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice