Provider Demographics
NPI:1720290802
Name:SIMONSEN, CHRIS REED (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:REED
Last Name:SIMONSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 500 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-3873
Mailing Address - Country:US
Mailing Address - Phone:801-295-5501
Mailing Address - Fax:801-295-5855
Practice Address - Street 1:535 E 500 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-3873
Practice Address - Country:US
Practice Address - Phone:801-295-5501
Practice Address - Fax:801-295-5855
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134220-99211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry