Provider Demographics
NPI:1962716977
Name:SIMIONESCU, BOGDAN V (DMD)
Entity type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:V
Last Name:SIMIONESCU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105A NEWTOWN ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-744-7377
Mailing Address - Fax:203-744-7403
Practice Address - Street 1:105 NEWTOWN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4194
Practice Address - Country:US
Practice Address - Phone:203-744-7377
Practice Address - Fax:203-744-7403
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist