Provider Demographics
NPI:1417076191
Name:SIMON, RACHAEL LARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:LARA
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 1:11862 RAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1417
Mailing Address - Country:US
Mailing Address - Phone:410-878-2211
Mailing Address - Fax:
Practice Address - Street 1:1134 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3826
Practice Address - Country:US
Practice Address - Phone:410-788-4555
Practice Address - Fax:410-744-0142
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD124141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry