1679790687 NPI number — DR. ANASTASIA BORISOVA PETKOVA DDS

Table of content: DR. ANASTASIA BORISOVA PETKOVA DDS (NPI 1679790687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679790687 NPI number — DR. ANASTASIA BORISOVA PETKOVA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETKOVA
Provider First Name:
ANASTASIA
Provider Middle Name:
BORISOVA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679790687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 FORBES AVENUE, FORBES TOWER-PLAZA LEVEL SUITE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-495-2535
Provider Business Mailing Address Fax Number:
303-327-7229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DENTAL ANESTHESIOLOGY
Provider Second Line Business Practice Location Address:
3501 TERRACE 8FR, G-89 SALK HALL ANNEX
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-495-2535
Provider Business Practice Location Address Fax Number:
303-327-7229
Provider Enumeration Date:
04/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  9345 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DEN9345 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00872733 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".