Provider Demographics
NPI:1881067700
Name:SIMON, SAMANTHA JO (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JO
Last Name:SIMON
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3918
Mailing Address - Country:US
Mailing Address - Phone:303-604-2804
Mailing Address - Fax:
Practice Address - Street 1:2820 LEMAY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3918
Practice Address - Country:US
Practice Address - Phone:303-604-2804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN202695122300000X
TN12632122300000X
MO2024040277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist