Provider Demographics
NPI:1083155816
Name:SIMIEN, ANASTATIA JOY (DDS)
Entity Type:Individual
Prefix:
First Name:ANASTATIA
Middle Name:JOY
Last Name:SIMIEN
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 1:2001 NW EVANGELINE TRWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-1927
Mailing Address - Country:US
Mailing Address - Phone:225-425-5122
Mailing Address - Fax:
Practice Address - Street 1:2001 NW EVANGELINE TRWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-1927
Practice Address - Country:US
Practice Address - Phone:225-425-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA69121223G0001X
VI2435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10271246Medicaid