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1760759245
DEREK S SIMON
NOME, AK
NPI
1760759245
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
124Q00000X Dental Hygienist
(Licence: AK 07-045-EFDHA I)
Enumeration Date
2011-11-28
Last Update Date
2011-11-28
Business Address
DEREK S SIMON DHA
306 WEST FIFTH AVENUE
NOME, AK 99762
Phone number: 907-443-3309
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Mailing Address
DEREK S SIMON DHA
PO BOX 966
NOME, AK 99762-0966
Phone number: 907-443-3309
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