Provider Demographics
NPI:1043819758
Name:SIMONCA, ALINA D
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:D
Last Name:SIMONCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 WILDCAT CLIFFS WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2972
Mailing Address - Country:US
Mailing Address - Phone:678-787-6504
Mailing Address - Fax:
Practice Address - Street 1:3780 OLD NORCROSS RD STE 303
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1742
Practice Address - Country:US
Practice Address - Phone:470-228-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH011031124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist