Keith Gerard Simons, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6716-15 Issued in WI

Practice address

1204 Merrill Ave
Wausau, WI 54401

Phone

(715) 842-3704

Fax

(715) 842-4207

NPI assigned

Jun 13, 2011

Last updated

Dec 18, 2024By the provider in NPPES

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

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.

• Quirt Family Dentistry SC

  • Dentist
  • Schofield, WI
  • NPI 1205976776
  NPD (past)
• Quirt Family Dentistry, SC

  dba Quirt Family Dental - Schofield

  • General Practice Dentistry
  • Schofield, WI
  • NPI 1306112685
  NPD (past)

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

{
    "created_epoch": "1307923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1679868111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 MERRILL AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "54401",
            "telephone_number": "715-842-3704",
            "fax_number": "715-842-4207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 MERRILL AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "54401",
            "telephone_number": "715-842-3704",
            "fax_number": "715-842-4207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONS",
        "first_name": "KEITH",
        "middle_name": "GERARD",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-13",
        "last_updated": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6716015",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6716-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Sigler Edmundson, MS.,LPC.,CSAC,ICS
• Melissa Sue Sigmund, AUD
• Mandy L Sikorski, APNP
• Jennie Simms
• Tanya Ann Simonis, PH.D
• Toni Simonson, LPC, SAC
• Thomas H Sirianni, HIS HEARING INSTRUME
• Tina M Sitko, SAC-IT
• Beth Skaggs
• Shannon Skaistis, PHD

• General Practice Dentistry in Wausau, WI
• Providers in Wausau, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.