Provider Demographics
NPI:1831954007
Name:SIMEON O UDUNKA DDS PLLC
Entity type:Organization
Organization Name:SIMEON O UDUNKA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SIMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:UDUNKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-987-0242
Mailing Address - Street 1:7750 N MACARTHUR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7501
Mailing Address - Country:US
Mailing Address - Phone:972-987-0242
Mailing Address - Fax:
Practice Address - Street 1:5618 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209
Practice Address - Country:US
Practice Address - Phone:214-429-3244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental