Provider Demographics
NPI:1275729956
Name:GEDEON, SIMON VICTOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:VICTOR
Last Name:GEDEON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 S BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2340
Mailing Address - Country:US
Mailing Address - Phone:914-378-0918
Mailing Address - Fax:914-378-0932
Practice Address - Street 1:460 S BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-2340
Practice Address - Country:US
Practice Address - Phone:914-378-0918
Practice Address - Fax:914-378-0932
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054638122300000X
NJDI02323700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist