Provider Demographics
NPI:1881850576
Name:SIMON, KATHRYN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:A
Last Name:SIMON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2138
Mailing Address - Country:US
Mailing Address - Phone:314-371-0336
Mailing Address - Fax:314-531-0063
Practice Address - Street 1:4352 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2138
Practice Address - Country:US
Practice Address - Phone:314-371-0336
Practice Address - Fax:314-531-0063
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011012531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist