Provider Demographics
NPI:1831233204
Name:KISS, SIMONA DRAGA (DDS)
Entity type:Individual
Prefix:MRS
First Name:SIMONA
Middle Name:DRAGA
Last Name:KISS
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 1:18102 IRVINE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3424
Mailing Address - Country:US
Mailing Address - Phone:714-730-9656
Mailing Address - Fax:714-730-9678
Practice Address - Street 1:18102 IRVINE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3424
Practice Address - Country:US
Practice Address - Phone:714-730-9656
Practice Address - Fax:714-730-9678
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice