Provider Demographics
NPI:1518188796
Name:SIMLOTE, PRAVEEN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:K
Last Name:SIMLOTE
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 1:6607 KINNE RD.
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:NY
Mailing Address - Zip Code:13214
Mailing Address - Country:US
Mailing Address - Phone:315-446-6406
Mailing Address - Fax:
Practice Address - Street 1:6607 KINNE RD.
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:NY
Practice Address - Zip Code:13214
Practice Address - Country:US
Practice Address - Phone:315-446-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist