Healthcare Provider Details

I. General information

NPI: 1235669615
Provider Name (Legal Business Name): SIMA ZITOUNI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MCKENZIE AVE STE 207
COUNCIL BLUFFS IA
51503-1002
US

IV. Provider business mailing address

13231 NICHOLAS CIR
OMAHA NE
68154-5134
US

V. Phone/Fax

Practice location:
  • Phone: 712-435-0992
  • Fax: 402-552-2330
Mailing address:
  • Phone: 402-651-9341
  • Fax: 402-552-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDDS-09342
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: