Provider Demographics
NPI:1992922132
Name:SIMONE, DAVID GARY (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GARY
Last Name:SIMONE
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 1:300 SKOKIE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1625
Mailing Address - Country:US
Mailing Address - Phone:847-291-1193
Mailing Address - Fax:847-291-0462
Practice Address - Street 1:300 SKOKIE BLVD STE D
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1625
Practice Address - Country:US
Practice Address - Phone:847-291-1193
Practice Address - Fax:847-291-0462
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BS5688859OtherDEA #