Provider Demographics
NPI:1518538503
Name:BADZIAI, ANASTASIYA (DMD)
Entity Type:Individual
Prefix:
First Name:ANASTASIYA
Middle Name:
Last Name:BADZIAI
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 1:4501 CIRCLE 75 PKWY SE APT 1413
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4280
Mailing Address - Country:US
Mailing Address - Phone:347-217-1051
Mailing Address - Fax:
Practice Address - Street 1:4125 GEORGE BUSBEE PKWY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7107
Practice Address - Country:US
Practice Address - Phone:347-217-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043060122300000X
GADN1230121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist