Provider Demographics
NPI:1235321654
Name:LAUREN M. SIMON, DDS, PLLC
Entity Type:Organization
Organization Name:LAUREN M. SIMON, DDS, PLLC
Other - Org Name:NOKESVILLE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-594-2151
Mailing Address - Street 1:12905 FITZWATER DR
Mailing Address - Street 2:
Mailing Address - City:NOKESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20181-2230
Mailing Address - Country:US
Mailing Address - Phone:703-594-2151
Mailing Address - Fax:703-594-2991
Practice Address - Street 1:12908 FITZWATER DRIVE
Practice Address - Street 2:
Practice Address - City:NOKESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20181-2241
Practice Address - Country:US
Practice Address - Phone:703-594-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014136181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7803168Medicaid