Provider Demographics
NPI:1275694606
Name:AHUJA, SIMONE K (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:K
Last Name:AHUJA
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 1:3938 CEDAR GROVE PKWY
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1403
Mailing Address - Country:US
Mailing Address - Phone:651-452-9660
Mailing Address - Fax:651-406-5941
Practice Address - Street 1:3938 CEDAR GROVE PKWY
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1403
Practice Address - Country:US
Practice Address - Phone:651-452-9660
Practice Address - Fax:651-406-5941
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist