Provider Demographics
NPI:1174182463
Name:AU, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:AU
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 1:1000 SW 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2953
Mailing Address - Country:US
Mailing Address - Phone:954-478-6466
Mailing Address - Fax:
Practice Address - Street 1:7505 GRAND LELY DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-1753
Practice Address - Country:US
Practice Address - Phone:352-273-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist