Provider Demographics
NPI:1881746576
Name:SIMONCELLI, JOHN PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN PAUL
Middle Name:
Last Name:SIMONCELLI
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:PO BOX 415
Mailing Address - Street 2:34 EAST STREET
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759
Mailing Address - Country:US
Mailing Address - Phone:860-567-3838
Mailing Address - Fax:860-567-3830
Practice Address - Street 1:34 EAST STREET
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759
Practice Address - Country:US
Practice Address - Phone:860-567-3838
Practice Address - Fax:860-567-3830
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT70831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice