Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 2901019838 | MI |
N | 213EG0000X | General Practice | 2901019838 | MI |
Y | 1223P0221X | Pediatric Dentist | 2901019838 | MI |
N | 1223P0221X | Pediatric Dentist | DT-2349 | HI |
NPI | 1073775516 |
---|---|
Provider Name | Dr. Thomas H Simon |
First Address | Grant, MI 49327-7900 |
Second Address | Grant, MI 49327-7900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 08/09/2015 |