Jordan Simon, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS041897 Issued in PA

Practice address

210 Carverton Rd
Trucksville, PA 18708-1745

Phone

(570) 696-1105

NPI assigned

Jul 30, 2018

Last updated

Jul 30, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Back Mountain Dental, Inc.

  • General Practice Dentistry
  • Trucksville, PA
  • NPI 1245301381
  NPD (past)

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

{
    "created_epoch": "1532908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1447738778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1982 W 8TH ST",
            "city": "WEST WYOMING",
            "state": "PA",
            "postal_code": "186449434",
            "telephone_number": "570-466-2705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 CARVERTON RD",
            "city": "TRUCKSVILLE",
            "state": "PA",
            "postal_code": "187081745",
            "telephone_number": "570-696-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "JORDAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-30",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS041897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chiropractic and Rehab Associates of Dallas, PC
• James Clemens Definnis, DMD
• Brandon Michael Jayne, MSPT
• Angela Lynn
• Mark Evan Morris, D.C.
• Trucksville Pharmacy LLC (Trucksville Pharmacy)

• General Practice Dentistry in Trucksville, PA
• Providers in Trucksville, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; 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.