Provider Demographics
NPI:1184605776
Name:SIMON, DANIEL JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:SIMON
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 1:595 BUCKINGHAM WAY STE 532
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1913
Mailing Address - Country:US
Mailing Address - Phone:415-566-2313
Mailing Address - Fax:
Practice Address - Street 1:595 BUCKINGHAM WAY STE 532
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1913
Practice Address - Country:US
Practice Address - Phone:415-566-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214611223E0200X
CA577581223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics