Provider Demographics
NPI:1922011709
Name:SIMON, JONATHAN LEWIS (DMD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:LEWIS
Last Name:SIMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14715 W 64TH AVE
Mailing Address - Street 2:UNIT F
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004
Mailing Address - Country:US
Mailing Address - Phone:303-940-7166
Mailing Address - Fax:303-996-0503
Practice Address - Street 1:14715 W 64TH AVE
Practice Address - Street 2:UNIT F
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004
Practice Address - Country:US
Practice Address - Phone:303-940-7166
Practice Address - Fax:303-996-0503
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist