Provider Demographics
NPI:1346680378
Name:UDUNKA, SIMEON O (DDS)
Entity Type:Individual
Prefix:
First Name:SIMEON
Middle Name:O
Last Name:UDUNKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 N MACARTHUR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7501
Mailing Address - Country:US
Mailing Address - Phone:972-987-0242
Mailing Address - Fax:
Practice Address - Street 1:3939 S POLK ST STE 310
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4406
Practice Address - Country:US
Practice Address - Phone:972-362-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist