Provider Demographics
NPI:1205388360
Name:SIMO, MINEL RACHEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MINEL
Middle Name:RACHEL
Last Name:SIMO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4402
Mailing Address - Country:US
Mailing Address - Phone:732-940-0222
Mailing Address - Fax:
Practice Address - Street 1:2229 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4402
Practice Address - Country:US
Practice Address - Phone:732-940-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02639500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist