Provider Demographics
NPI:1750076618
Name:SIMARD, ALISON MARY (DDS)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:MARY
Last Name:SIMARD
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 1:2471 NORTH NAGLEE ROAD SUITE 100
Mailing Address - Street 2:UNIT 1089
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304
Mailing Address - Country:US
Mailing Address - Phone:413-485-8293
Mailing Address - Fax:
Practice Address - Street 1:1800 TULLY RD STE A2
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2923
Practice Address - Country:US
Practice Address - Phone:209-527-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109351122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program