Provider Demographics
NPI:1043516602
Name:NASH, NATASHIA FAYE (DENTAL ASST)
Entity type:Individual
Prefix:
First Name:NATASHIA
Middle Name:FAYE
Last Name:NASH
Suffix:
Gender:F
Credentials:DENTAL ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 BRASELTON HWY SUITE C
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5932
Mailing Address - Country:US
Mailing Address - Phone:678-353-1049
Mailing Address - Fax:678-714-7525
Practice Address - Street 1:3635 BRASELTON HWY STE C
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5932
Practice Address - Country:US
Practice Address - Phone:678-353-1049
Practice Address - Fax:678-714-7525
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant