Provider Demographics
NPI:1700937406
Name:SIMON, HARVEY P (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:P
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 1:225 MAIN ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3216
Mailing Address - Country:US
Mailing Address - Phone:203-222-9553
Mailing Address - Fax:203-222-0129
Practice Address - Street 1:225 MAIN ST
Practice Address - Street 2:STE. 201
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3216
Practice Address - Country:US
Practice Address - Phone:203-222-9553
Practice Address - Fax:203-222-0129
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77881223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics