MEDICARE: DR. SIMONE K. AHUJA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D11053	MN

General Provider Information

NPI Number	:	1275694606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMONE K. AHUJA DDS

Provider Business Mailing Address
First Line	:	3938 CEDAR GROVE PKWY
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-1403
Country	:	US
Telephone Number	:	651-452-9660
Fax Number	:	651-406-5941

Provider Business Practice Location Address
First Line	:	3938 CEDAR GROVE PKWY
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-1403
Country	:	US
Telephone Number	:	651-452-9660
Fax Number	:	651-406-5941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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