| Doctor Name: | SAMIE C. SIMON |
| NPI Number: | 1750598751 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.D. |
| License Number: | DT DO773331 |
| Business Practice Address: | 2495 Newmark St North Bend, OR - 974591121 |
| Business Phone Number: | 5417562121 |
| Business Fax Number: | 5417566326 |
| Mailing Address: | 2495 Newmark St, NORTH BEND |
| State: | OR |
| Postal Code: | 974591121 |
| Phone Number: | 5417562121 |
| Fax Number: | 5417566326 |
| NPI Enumeration Date: | 05/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DT DO773331 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |