Provider Demographics
NPI:1437346897
Name:SIMONS, CHARLES CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:SIMONS
Suffix:
Gender:M
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:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-0600
Mailing Address - Country:US
Mailing Address - Phone:906-387-5000
Mailing Address - Fax:906-387-5018
Practice Address - Street 1:N6141 INDUSTRIAL PARK RD.
Practice Address - Street 2:
Practice Address - City:WETMORE
Practice Address - State:MI
Practice Address - Zip Code:49895
Practice Address - Country:US
Practice Address - Phone:906-387-5000
Practice Address - Fax:906-387-5018
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist