Provider Demographics
NPI:1912262841
Name:SIMONOVICH, SVETLANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:SIMONOVICH
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 1:1813 MCCLARY ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14207 COIT RD
Practice Address - Street 2:SUITE 12
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-2700
Practice Address - Country:US
Practice Address - Phone:972-490-1600
Practice Address - Fax:972-490-1620
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice