Provider Demographics
NPI:1366654212
Name:SIMON, GARY D (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:SIMON
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 1:3565 CROMPOND RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-7232
Mailing Address - Country:US
Mailing Address - Phone:914-736-6668
Mailing Address - Fax:914-736-6669
Practice Address - Street 1:3565 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-7232
Practice Address - Country:US
Practice Address - Phone:914-736-6668
Practice Address - Fax:914-736-6669
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0414171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice