Provider Demographics
NPI:1912150384
Name:SIMONS, MARK (DMD,MSD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SIMONS
Suffix:
Gender:M
Credentials:DMD,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N 182ND ST STE 303
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4400
Mailing Address - Country:US
Mailing Address - Phone:206-542-7575
Mailing Address - Fax:206-542-5552
Practice Address - Street 1:721 N 182ND ST STE 303
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4400
Practice Address - Country:US
Practice Address - Phone:206-542-7575
Practice Address - Fax:206-542-5552
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA38881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics