Provider Demographics
NPI:1548394067
Name:SIMON, BARRY JOEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:JOEL
Last Name:SIMON
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 1:4030 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1957
Mailing Address - Country:US
Mailing Address - Phone:513-631-8920
Mailing Address - Fax:513-631-8921
Practice Address - Street 1:4030 SMITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1957
Practice Address - Country:US
Practice Address - Phone:513-631-8920
Practice Address - Fax:513-631-8921
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist