Provider Demographics
NPI:1891874525
Name:SIMON & SIMON DDS
Entity type:Organization
Organization Name:SIMON & SIMON DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-875-4295
Mailing Address - Street 1:2840 DELAWARE AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217
Mailing Address - Country:US
Mailing Address - Phone:716-875-4295
Mailing Address - Fax:716-876-8237
Practice Address - Street 1:2840 DELAWARE AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217
Practice Address - Country:US
Practice Address - Phone:716-875-4295
Practice Address - Fax:716-876-8237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041811122300000X
NY20083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty