Robert Anthony Simon, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

30924 Issued in TX

Practice address

7925 S Broadway Ave Ste 1100
Tyler, TX 75703-5227

Phone

(903) 213-9799

NPI assigned

Jul 22, 2015

Sex

Male

Sole proprietor

Yes

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Simon Dental Services PLLC

  • Dental Clinic/Center
  • Tyler, TX
  • NPI 1124747258
  NPD Authorized official

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1619352499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2872 BARTON CREEK CIR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757037079",
            "telephone_number": "409-670-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7925 S BROADWAY AVE STE 1100",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035227",
            "telephone_number": "903-213-9799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "ROBERT",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-22",
        "last_updated": "2022-10-07",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "30924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane D Simmons, LPC
• Mitchel J.D. Simmons, PTA
• Patricia Brooke Simmons, WHNP
• Stephanie Jernigan Simmons, PSYD
• Simon Dental Services PLLC
• Paige Lackey Simons, PA-C
• Zackery Ryan Simons
• Simply Serenity Healthcare Agency LLC
• Simply Serenity Healthcare Agency LLC
• Simply Serenity Healthcare Agency LLC

• Dentist in Tyler, TX
• Providers in Tyler, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.