Provider Demographics
NPI:1689857716
Name:SIMESCU, CODRUTA V (DMD)
Entity Type:Individual
Prefix:
First Name:CODRUTA
Middle Name:V
Last Name:SIMESCU
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 1:6735 FM 78 STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1368
Mailing Address - Country:US
Mailing Address - Phone:210-661-6200
Mailing Address - Fax:210-661-6684
Practice Address - Street 1:6735 FM 78 STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1368
Practice Address - Country:US
Practice Address - Phone:210-661-6200
Practice Address - Fax:210-661-6684
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice