Provider Demographics
NPI:1871706671
Name:WORKMAN, ANITA LOUISE
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:LOUISE
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:LOUISE
Other - Last Name:BROWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1383 STATE ROUTE 43
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-8814
Mailing Address - Country:US
Mailing Address - Phone:330-628-3613
Mailing Address - Fax:
Practice Address - Street 1:1383 STATE ROUTE 43
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-8814
Practice Address - Country:US
Practice Address - Phone:330-628-3613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist