Provider Demographics
NPI:1508862293
Name:SIMONDS, CARY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:B
Last Name:SIMONDS
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:ORAL SURGERY PLUS
Mailing Address - Street 2:123 W FRANCIS
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205
Mailing Address - Country:US
Mailing Address - Phone:509-928-8800
Mailing Address - Fax:509-321-0154
Practice Address - Street 1:123 W FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6348
Practice Address - Country:US
Practice Address - Phone:509-928-8800
Practice Address - Fax:509-321-0154
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA75031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5026091Medicaid
WA5026091Medicaid