Provider Demographics
NPI:1497883532
Name:PAUL L SIMON DDS PLC
Entity Type:Organization
Organization Name:PAUL L SIMON DDS PLC
Other - Org Name:SOUTH LYON DENTAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-437-8300
Mailing Address - Street 1:21800 PONTIAC TRAIL
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178
Mailing Address - Country:US
Mailing Address - Phone:248-437-8300
Mailing Address - Fax:248-437-8066
Practice Address - Street 1:21800 PONTIAC TRAIL
Practice Address - Street 2:STE 100
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178
Practice Address - Country:US
Practice Address - Phone:248-437-8300
Practice Address - Fax:248-437-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010130281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty