Provider Demographics
NPI:1295246676
Name:SIMANIAN, EMIL JACOB (DDS)
Entity type:Individual
Prefix:DR
First Name:EMIL
Middle Name:JACOB
Last Name:SIMANIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23107 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2630
Mailing Address - Country:US
Mailing Address - Phone:661-254-3516
Mailing Address - Fax:
Practice Address - Street 1:23107 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2630
Practice Address - Country:US
Practice Address - Phone:661-254-3516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist