Rowdy J Simon, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7861 Issued in OK

Practice address

720 S Thornton St
Vian, OK 74962

Phone

(918) 773-6200

NPI assigned

Feb 16, 2024

Sex

Male

Sole proprietor

No

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": "1708041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1124883335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96940 S 4507 RD",
            "city": "VIAN",
            "state": "OK",
            "postal_code": "749621672",
            "telephone_number": "918-773-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 S THORNTON ST",
            "city": "VIAN",
            "state": "OK",
            "postal_code": "74962",
            "telephone_number": "918-773-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "ROWDY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-16",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OK",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "7861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelyce Phipps
• Pioneer Lab Solutions LLC
• Red Haven Therapy
• Jesse Rouse
• Belinda Scoggins-Kokendoffer
• Amber L. Spyres, BSN, RN
• Leann Stewart
• Cary Patrick Sullivan, D.O.
• Heather Summerlin
• Tenkiller Family Chiropracitc

• General Practice Dentistry in Vian, OK
• Providers in Vian, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.