Provider Demographics
NPI:1083935381
Name:ZMUIDZINAS, SIMONAS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SIMONAS
Middle Name:
Last Name:ZMUIDZINAS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 MAYFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4006
Mailing Address - Country:US
Mailing Address - Phone:585-200-3797
Mailing Address - Fax:
Practice Address - Street 1:1957 MAYFLOWER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4006
Practice Address - Country:US
Practice Address - Phone:917-392-5113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT107771223X0400X
NH023691223X0400X
CO96011223X0400X
OH30-01-80461223X0400X
PADS026161L1223X0400X
MADN174201223X0400X
IL019-0220191223X0400X
NY50 0500131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics