Active NPI
Thomas H Simon, DDS
- Pediatric Dentistry
- Grant, MI
National Provider Identifier
1073775516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2901019838
- Practice address
- 11 N Maple St
Grant, MI 49327-7900 - Phone
- (231) 834-9754
- Fax
- (231) 834-1895
- NPI assigned
- Jun 26, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901019838 | MI | |
| Pediatric Dentistry | 1223P0221X | DT-2349 | HI | |
| Pediatric Dentistry | 1223P0221X | 2901019838 | MI | Primary |
Addresses
Primary practice location
11 N Maple St
Grant, MI 49327-7900
Mailing address
11 N Maple St
PO Box 7
Grant, MI 49327-7900
Phone (231) 834-9754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT-2349 | HI | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441670400000",
"number": "1073775516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 N MAPLE ST",
"address_2": "PO BOX 7",
"city": "GRANT",
"state": "MI",
"postal_code": "493277900",
"telephone_number": "231-834-9754",
"fax_number": "231-834-1895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 N MAPLE ST",
"city": "GRANT",
"state": "MI",
"postal_code": "493277900",
"telephone_number": "231-834-9754",
"fax_number": "231-834-1895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "THOMAS",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-26",
"last_updated": "2015-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901019838",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "HI",
"license": "DT-2349",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MI",
"license": "2901019838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grant, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.