Provider Demographics
NPI:1619965050
Name:SIMONYAN, NAIRA (DMD)
Entity Type:Individual
Prefix:
First Name:NAIRA
Middle Name:
Last Name:SIMONYAN
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 1:2155 KETTNER BLVD UNIT 312
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1747
Mailing Address - Country:US
Mailing Address - Phone:312-402-2072
Mailing Address - Fax:312-402-2072
Practice Address - Street 1:1111 6TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5214
Practice Address - Country:US
Practice Address - Phone:619-817-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0266071223G0001X
CA1072811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice