Provider Demographics
NPI:1891154779
Name:SIMON J ADIR DDS, PLLC
Entity Type:Organization
Organization Name:SIMON J ADIR DDS, PLLC
Other - Org Name:WAXHAW DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-243-1122
Mailing Address - Street 1:2514 CUTHBERTSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6417
Mailing Address - Country:US
Mailing Address - Phone:704-243-1122
Mailing Address - Fax:
Practice Address - Street 1:2514 CUTHBERTSON RD STE A
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6417
Practice Address - Country:US
Practice Address - Phone:704-243-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental