Provider Demographics
NPI:1790049047
Name:SIMON, EMILY P (DMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:P
Last Name:SIMON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 SHERWOOD PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3444
Mailing Address - Country:US
Mailing Address - Phone:678-450-7011
Mailing Address - Fax:678-971-4201
Practice Address - Street 1:1207 SHERWOOD PARK DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3444
Practice Address - Country:US
Practice Address - Phone:678-450-7011
Practice Address - Fax:678-971-4201
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0144241223P0221X
VA0442000204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry