Provider Demographics
NPI:1518121920
Name:NASTASA, ANCA IULIANA
Entity Type:Individual
Prefix:MRS
First Name:ANCA
Middle Name:IULIANA
Last Name:NASTASA
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 1:300 E LONK LAKE STE 311
Mailing Address - Street 2:GREAT EXPRESSIONS DENTAL CENTERS
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304
Mailing Address - Country:US
Mailing Address - Phone:248-203-1119
Mailing Address - Fax:248-723-0052
Practice Address - Street 1:2041 FIFTEEN MILE RD
Practice Address - Street 2:GREAT EXPRESSIONAL DENTAL CENTERS
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-268-0900
Practice Address - Fax:586-268-0909
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist