Michael Kevin Simonetti

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

063487 Issued in NY

Practice address

9405 S Avenida del Yaqui
Guadalupe, AZ 85283-2529

Phone

(480) 768-2000

NPI assigned

Mar 9, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1083361950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 RICHMOND AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142221997",
            "telephone_number": "631-356-5629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9405 S AVENIDA DEL YAQUI",
            "city": "GUADALUPE",
            "state": "AZ",
            "postal_code": "852832529",
            "telephone_number": "480-768-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONETTI",
        "first_name": "MICHAEL",
        "middle_name": "KEVIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-09",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "063487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pascua Yaqui Tribe
• Pascua Yaqui Tribe
• Gloria M Rosales, LISAC
• Grant Satterthwaite
• Michael N. Shanley, LCSW, LISAC
• Jody Lynn Tierney, LCSW
• Oghenetega Ewefada Vance, FNP
• David T Wilson, DO
• Qi Wen Xin, D.O.

• General Practice Dentistry in Guadalupe, AZ
• Providers in Guadalupe, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.