Provider Demographics
NPI:1073775516
Name:SIMON, THOMAS H (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:SIMON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 N MAPLE ST
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-7900
Mailing Address - Country:US
Mailing Address - Phone:231-834-9754
Mailing Address - Fax:231-834-1895
Practice Address - Street 1:11 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:MI
Practice Address - Zip Code:49327-7900
Practice Address - Country:US
Practice Address - Phone:231-834-9754
Practice Address - Fax:231-834-1895
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010198381223G0001X, 1223P0221X
HIDT-23491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice