Active NPI
Polina P Simanovich, DMD
- Prosthodontics
- Meriden, CT
National Provider Identifier
1770743171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 10452
- Practice address
- 727 Broad St
Meriden, CT 06450-4341 - Phone
- (203) 235-1415
- NPI assigned
- Jun 10, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Customized Equipment (DME) | 332BC3200X | |||
| Prosthodontics | 1223P0700X | 10452 | CT | Primary |
Addresses
Primary practice location
727 Broad St
Meriden, CT 06450-4341
Mailing address
727 Broad St
Meriden, CT 06450-4341
Phone (203) 235-1415
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10452 | CT | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Dental P C | Prosthodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604361600000",
"number": "1770743171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "727 BROAD ST",
"city": "MERIDEN",
"state": "CT",
"postal_code": "064504341",
"telephone_number": "203-235-1415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "727 BROAD ST",
"city": "MERIDEN",
"state": "CT",
"postal_code": "064504341",
"telephone_number": "203-235-1415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMANOVICH",
"first_name": "POLINA",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-10",
"last_updated": "2020-11-03",
"certification_date": "2020-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "332BC3200X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CT",
"license": "10452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meriden, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.