Provider Demographics
NPI:1679764351
Name:SIMON, JOHN R (D D S)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:SIMON
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2413
Mailing Address - Country:US
Mailing Address - Phone:973-635-8559
Mailing Address - Fax:973-635-5755
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2413
Practice Address - Country:US
Practice Address - Phone:973-635-8559
Practice Address - Fax:973-635-5755
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ198021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice