Provider Demographics
NPI:1417436320
Name:SIMEON O. UDUNKA, DDS, P.A.
Entity Type:Organization
Organization Name:SIMEON O. UDUNKA, DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:UDUNKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-293-8500
Mailing Address - Street 1:241 E FM 1382
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2145
Mailing Address - Country:US
Mailing Address - Phone:972-293-8500
Mailing Address - Fax:
Practice Address - Street 1:241 E FM 1382
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2145
Practice Address - Country:US
Practice Address - Phone:972-293-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty