Provider Demographics
NPI:1326015702
Name:COMBS, ANASTASIA MORGAN (DMD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:MORGAN
Last Name:COMBS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 437169
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-7169
Mailing Address - Country:US
Mailing Address - Phone:502-254-8537
Mailing Address - Fax:
Practice Address - Street 1:2300 TERRA CROSSING BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5906
Practice Address - Country:US
Practice Address - Phone:502-709-7285
Practice Address - Fax:502-305-6520
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82001223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60003563Medicaid
KY7100191280OtherEPSDT