Provider Demographics
NPI:1962571018
Name:DR DENIS E SIMON III, DR MICHAEL SCOTT BOND AND GWENDOLYN DENISE CO
Entity type:Organization
Organization Name:DR DENIS E SIMON III, DR MICHAEL SCOTT BOND AND GWENDOLYN DENISE CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:225-766-3061
Mailing Address - Street 1:9804 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6442
Mailing Address - Country:US
Mailing Address - Phone:225-766-3061
Mailing Address - Fax:225-766-3199
Practice Address - Street 1:9804 BLUEBONNET BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6442
Practice Address - Country:US
Practice Address - Phone:225-766-3061
Practice Address - Fax:225-766-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty