Provider Demographics
NPI:1629409131
Name:SIMON, S. LAWRENCE (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:S. LAWRENCE
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CENTRAL PARK S
Mailing Address - Street 2:SUITE 10- D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1628
Mailing Address - Country:US
Mailing Address - Phone:212-317-2055
Mailing Address - Fax:212-317-2056
Practice Address - Street 1:30 CENTRAL PARK S
Practice Address - Street 2:SUITE 10- D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1628
Practice Address - Country:US
Practice Address - Phone:212-317-2055
Practice Address - Fax:212-317-2056
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0246621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAS3135298OtherDEA