Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH011031 | GA |
NPI | 1043819758 |
---|---|
Provider Name | Alina D Simonca |
First Address | Lawrenceville, GA 30043-2972 |
Second Address | Duluth, GA 30096-1742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2020 |
Last Update Date | 22/10/2020 |