Provider Demographics
NPI:1407086796
Name:SIMON ORTHODONTIC CENTERS P.A.
Entity Type:Organization
Organization Name:SIMON ORTHODONTIC CENTERS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-385-0911
Mailing Address - Street 1:13716 SW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4040
Mailing Address - Country:US
Mailing Address - Phone:305-385-0911
Mailing Address - Fax:305-385-2104
Practice Address - Street 1:13716 SW 84TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4040
Practice Address - Country:US
Practice Address - Phone:305-385-0911
Practice Address - Fax:305-385-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN57811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty