Provider Demographics
NPI:1518270479
Name:TROFIMOV, SIMONA (DDS)
Entity type:Individual
Prefix:DR
First Name:SIMONA
Middle Name:
Last Name:TROFIMOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1077
Mailing Address - Country:US
Mailing Address - Phone:860-673-3133
Mailing Address - Fax:
Practice Address - Street 1:162 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2091
Practice Address - Country:US
Practice Address - Phone:860-668-0241
Practice Address - Fax:860-668-8788
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0103061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010306OtherDENTAL LICENCE ISSUED BY STATE OF CONNECTICUT - DEPARTMENT OF PUBLIC HEALTH