Provider Demographics
NPI:1053765750
Name:ROBERT M SIMONS LTD
Entity type:Organization
Organization Name:ROBERT M SIMONS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-772-3487
Mailing Address - Street 1:2401 S WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6747
Mailing Address - Country:US
Mailing Address - Phone:701-772-3487
Mailing Address - Fax:701-772-4917
Practice Address - Street 1:2401 S WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6747
Practice Address - Country:US
Practice Address - Phone:701-772-3487
Practice Address - Fax:701-772-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty