Provider Demographics
NPI:1982802377
Name:SIMON, LEE J (DDS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:J
Last Name:SIMON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LEE
Other - Middle Name:J
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:410 CRANBERRY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1067
Mailing Address - Country:US
Mailing Address - Phone:814-452-3442
Mailing Address - Fax:814-455-5104
Practice Address - Street 1:410 CRANBERRY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1067
Practice Address - Country:US
Practice Address - Phone:814-452-3442
Practice Address - Fax:814-455-5104
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022407L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist