Provider Demographics
NPI:1710700349
Name:SIMON, BRITTANY (BASDH)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:BASDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 AREZZO CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1112
Mailing Address - Country:US
Mailing Address - Phone:561-459-0026
Mailing Address - Fax:
Practice Address - Street 1:3911 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3902
Practice Address - Country:US
Practice Address - Phone:561-498-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH22607124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist