Individual
KEITH GERARD SIMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1204 MERRILL AVE, WAUSAU, WI 54401
(715) 842-3704
(715) 842-4207
Mailing address
1204 MERRILL AVE, WAUSAU, WI 54401
(715) 842-3704
(715) 842-4207
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6716015
WI
1223G0001X
General Practice Dentistry
Primary
6716-15
WI
Other
Enumeration date
06/13/2011
Last updated
12/18/2024
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