Provider Demographics
NPI:1164705679
Name:AVINA, ANASTASIA (DDS)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:AVINA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1060 W BUSCH BLVD
Practice Address - Street 2:105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7707
Practice Address - Country:US
Practice Address - Phone:813-931-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN195051223G0001X
CADN630671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice