Provider Demographics
NPI:1407473481
Name:SIMON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SIMON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-430-7049
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-0150
Mailing Address - Country:US
Mailing Address - Phone:479-430-7049
Mailing Address - Fax:479-430-7051
Practice Address - Street 1:191 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-3306
Practice Address - Country:US
Practice Address - Phone:479-430-7049
Practice Address - Fax:479-430-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental