Individual
FRED H SIMONTON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1221 SHERWOOD PARK DR NE STE C, GAINESVILLE, GA 30501-3404
(770) 531-1075
(770) 536-2815
Mailing address
1221 SHERWOOD PARK DR NE STE C, GAINESVILLE, GA 30501-3404
(770) 531-1075
(770) 536-2815
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
010367
GA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
10367
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000344462A
—
GA
Enumeration date
08/31/2006
Last updated
01/29/2019
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