Provider Demographics
NPI:1841346764
Name:SIMON, GREG J (DDS)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:J
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 1:607 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5419
Mailing Address - Country:US
Mailing Address - Phone:501-327-2586
Mailing Address - Fax:501-329-8934
Practice Address - Street 1:607 FRONT ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5419
Practice Address - Country:US
Practice Address - Phone:501-327-2586
Practice Address - Fax:501-329-8934
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR988211OtherUCCI PROVIDER NUMBER
AR5U236OtherARKANSAS BCBS PROVIDER #