Active NPI
Jaret Simonsen, DMD
- Periodontics
- Prescott, AZ
National Provider Identifier
1689396442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- D012445
- Practice address
- 3124 Stillwater Dr
Prescott, AZ 86305-7151 - Phone
- (928) 778-2340
- NPI assigned
- Sep 16, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | D012445 | AZ | Primary |
| Periodontics | 1223P0300X | ETN996 | TX |
Addresses
Primary practice location
3124 Stillwater Dr
Prescott, AZ 86305-7151
Mailing address
3124 Stillwater Dr
Prescott, AZ 86305-7151
Phone (928) 778-2340
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 |
|---|---|---|---|
| D012445 | AZ | MD | Periodontist |
| ETN996 | TX | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745884800000",
"number": "1689396442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3124 STILLWATER DR",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863057151",
"telephone_number": "928-778-2340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3124 STILLWATER DR",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863057151",
"telephone_number": "928-778-2340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMONSEN",
"first_name": "JARET",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-16",
"last_updated": "2025-04-29",
"certification_date": "2025-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "AZ",
"license": "D012445",
"primary": true
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "ETN996",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.