Provider Demographics
NPI:1942637871
Name:SIMOCA, MARIANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:
Last Name:SIMOCA
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 1:3636 WALDO AVE APT 6K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2257
Mailing Address - Country:US
Mailing Address - Phone:561-558-5833
Mailing Address - Fax:
Practice Address - Street 1:466 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5108
Practice Address - Country:US
Practice Address - Phone:718-365-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056991-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist