Healthcare Provider Details

I. General information

NPI: 1134650971
Provider Name (Legal Business Name): ANASTASIA KATSAVOCHRISTOU DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536
US

IV. Provider business mailing address

800 ROSE ST DENTAL SCIENCE BUILDING
LEXINGTON KY
40536
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-8873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021798
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901021798
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10367
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: