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NPI Code Detail

MEDICARE: SIMONA AWISZUS DDS

MEDICARE: SIMONA AWISZUS 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
1122300000XDentistD11716MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1610021000OTHERMNMEDICAL ASST PROVIDER #

General Provider Information

NPI Number : 1912968199
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIMONA AWISZUS DDS
Provider Business Mailing Address
First Line : 1026 7TH ST W
Second Line :
City : SAINT PAUL
State : MN
Zip : 55102-3828
Country : US
Telephone Number : 651-758-9500
Fax Number :
Provider Business Practice Location Address
First Line : 1026 7TH ST W
Second Line :
City : SAINT PAUL
State : MN
Zip : 55102-3828
Country : US
Telephone Number : 651-758-9500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 12/17/2024

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