Provider Demographics
NPI:1174530083
Name:SCHWARTZ, SIMON H (DDS)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:H
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12520 MAGNOLIA BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2344
Mailing Address - Country:US
Mailing Address - Phone:818-506-0868
Mailing Address - Fax:818-506-0094
Practice Address - Street 1:12520 MAGNOLIA BLVD
Practice Address - Street 2:STE 202
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2344
Practice Address - Country:US
Practice Address - Phone:818-506-0868
Practice Address - Fax:818-506-0094
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA252891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery