Provider Demographics
NPI:1316080732
Name:SIMON W YAMPOLSKI, DMD, PC
Entity type:Organization
Organization Name:SIMON W YAMPOLSKI, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:W
Authorized Official - Last Name:YAMPOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-478-2131
Mailing Address - Street 1:192 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2239
Mailing Address - Country:US
Mailing Address - Phone:508-478-2131
Mailing Address - Fax:508-634-3041
Practice Address - Street 1:192 WEST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2239
Practice Address - Country:US
Practice Address - Phone:508-478-2131
Practice Address - Fax:508-634-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9728147Medicaid