Provider Demographics
NPI:1275683021
Name:SIMON-VILLALBA, ANNA KARINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:KARINA
Last Name:SIMON-VILLALBA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 GALEN ST STE B
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4503
Mailing Address - Country:US
Mailing Address - Phone:617-926-9500
Mailing Address - Fax:617-926-9505
Practice Address - Street 1:51 GALEN ST STE 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4503
Practice Address - Country:US
Practice Address - Phone:617-926-9500
Practice Address - Fax:617-926-9505
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics