Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DIO18179 | NJ |
NPI | 1992989099 |
---|---|
Provider Name | Dr. Bettyjo Simas |
First Address | Bridgeton, NJ 08302 |
Second Address | Bridgeton, NJ 08302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2007 |
Last Update Date | 26/12/2007 |