Provider Demographics
NPI:1952469397
Name:SIMOS, SAM S (DDS)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:S
Last Name:SIMOS
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 1:818 CLARK STREET
Mailing Address - Street 2:
Mailing Address - City:MARSEILLES
Mailing Address - State:IL
Mailing Address - Zip Code:61341
Mailing Address - Country:US
Mailing Address - Phone:815-795-2320
Mailing Address - Fax:
Practice Address - Street 1:818 CLARK STREET
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341
Practice Address - Country:US
Practice Address - Phone:815-795-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice