Provider Demographics
NPI:1407241888
Name:SIMONI, ALBANA (DDS)
Entity Type:Individual
Prefix:
First Name:ALBANA
Middle Name:
Last Name:SIMONI
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 1:8538 ELGIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3629
Mailing Address - Country:US
Mailing Address - Phone:314-650-3771
Mailing Address - Fax:
Practice Address - Street 1:11437 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7108
Practice Address - Country:US
Practice Address - Phone:314-355-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0031081223S0112X
MO20210394161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery