Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 10367 | KY |
N | 122300000X | Dentist | 2901021798 | MI |
N | 1223P0700X | Prosthodontist | 2901021798 | MI |
NPI | 1134650971 |
---|---|
Provider Name | Anastasia Katsavochristou |
First Address | Lexington, KY 40536 |
Second Address | Lexington, KY 40536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 04/06/2020 |