Provider Demographics
NPI:1841855566
Name:SIMONSMILES, P.A.
Entity type:Organization
Organization Name:SIMONSMILES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-562-2844
Mailing Address - Street 1:4340 W HILLSBOROUGH AVE STE 702
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5560
Mailing Address - Country:US
Mailing Address - Phone:954-562-2844
Mailing Address - Fax:
Practice Address - Street 1:4340 W HILLSBOROUGH AVE STE 702
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5560
Practice Address - Country:US
Practice Address - Phone:954-562-2844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental