Active NPI
Ira R Simon, DDS
- Periodontics
- Novato, CA
National Provider Identifier
1356415772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 240396
- Practice address
- 1730 Novato Blvd
Suite G
Novato, CA 94947-3048 - Phone
- (415) 897-7770
- NPI assigned
- Nov 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 240396 | CA | Primary |
Addresses
Primary practice location
1730 Novato Blvd
Suite G
Novato, CA 94947-3048
Mailing address
1730 Novato Blvd Ste G
Novato, CA 94947-3048
Phone (415) 897-7770
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 240396 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356415772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1730 NOVATO BLVD STE G",
"city": "NOVATO",
"state": "CA",
"postal_code": "949473048",
"telephone_number": "415-897-7770",
"fax_number": "415-897-7704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1730 NOVATO BLVD",
"address_2": "SUITE G",
"city": "NOVATO",
"state": "CA",
"postal_code": "949473048",
"telephone_number": "415-897-7770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "IRA",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "240396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novato, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.