Provider Demographics
NPI:1568032589
Name:SHAMOON, SIMON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:SHAMOON
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 1:36138 WALTHAM DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4502
Mailing Address - Country:US
Mailing Address - Phone:586-498-6239
Mailing Address - Fax:
Practice Address - Street 1:5695 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-1619
Practice Address - Country:US
Practice Address - Phone:248-707-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53070107911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice