Provider Demographics
NPI:1447921978
Name:SIMONIAN, ANNA (DDS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SIMONIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 DOVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1148
Mailing Address - Country:US
Mailing Address - Phone:323-630-3903
Mailing Address - Fax:
Practice Address - Street 1:12650 SHERMAN WAY STE 7
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5248
Practice Address - Country:US
Practice Address - Phone:818-503-4900
Practice Address - Fax:818-503-4953
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice