Provider Demographics
NPI:1205809282
Name:SIMOS, CONSTANTINE (DMD)
Entity type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:
Last Name:SIMOS
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 1:109 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2410
Mailing Address - Country:US
Mailing Address - Phone:732-247-8083
Mailing Address - Fax:732-247-1584
Practice Address - Street 1:109 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2410
Practice Address - Country:US
Practice Address - Phone:732-247-8083
Practice Address - Fax:732-247-1584
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 215081223S0112X
NY0478531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051929 ATRMedicare ID - Type Unspecified
NJU-80389Medicare UPIN