Provider Demographics
NPI:1871796623
Name:SIMONI, MEHRZAD (DDS)
Entity type:Individual
Prefix:DR
First Name:MEHRZAD
Middle Name:
Last Name:SIMONI
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 1:31 EDWARDS ST
Mailing Address - Street 2:#2A
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1100
Mailing Address - Country:US
Mailing Address - Phone:917-533-2751
Mailing Address - Fax:
Practice Address - Street 1:23 BOND ST
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2025
Practice Address - Country:US
Practice Address - Phone:516-487-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry