Provider Demographics
NPI:1053558601
Name:WM. L. SIMKO & GEORGE HARITONOVICH DDS INC.
Entity type:Organization
Organization Name:WM. L. SIMKO & GEORGE HARITONOVICH DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARITONOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-779-7292
Mailing Address - Street 1:26777 LORAIN RD
Mailing Address - Street 2:#417
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3200
Mailing Address - Country:US
Mailing Address - Phone:440-779-7292
Mailing Address - Fax:440-779-0552
Practice Address - Street 1:26777 LORAIN RD
Practice Address - Street 2:#417
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3200
Practice Address - Country:US
Practice Address - Phone:440-779-7292
Practice Address - Fax:440-779-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-18
Last Update Date:2009-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH186531223G0001X
OH137591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty