Provider Demographics
NPI:1295824407
Name:SIMON, DEEPA NMI (DDS)
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:NMI
Last Name:SIMON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 BROOK RD
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1298
Mailing Address - Country:US
Mailing Address - Phone:804-321-7474
Mailing Address - Fax:804-228-5970
Practice Address - Street 1:2924 BROOK RD
Practice Address - Street 2:CREDENTIALING DEPT
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-1298
Practice Address - Country:US
Practice Address - Phone:804-321-7474
Practice Address - Fax:804-228-5970
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401411005OtherPROFESIONAL LICENSE