Provider Demographics
NPI:1194300624
Name:DOVZHENKO, ANASTASIYA
Entity type:Individual
Prefix:
First Name:ANASTASIYA
Middle Name:
Last Name:DOVZHENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 129TH PL SE APT B102
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1380
Mailing Address - Country:US
Mailing Address - Phone:801-712-7021
Mailing Address - Fax:
Practice Address - Street 1:7713 CENTER BLVD SE STE 240
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-6311
Practice Address - Country:US
Practice Address - Phone:425-292-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61234931122300000X
UT12833513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist