Basic Information
| Provider Information | |||||||||
| NPI: | 1407241888 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMONI | ||||||||
| FirstName: | ALBANA | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8538 ELGIN AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631233629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146503771 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11437 OLIVE BLVD | ||||||||
| Address2: | |||||||||
| City: | CREVE COEUR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631417108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143552000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2015 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 021.003108 | IL | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | 2021039416 | MO | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.