Provider Demographics
NPI:1558036947
Name:BEERS, ANNA VITALYEVNA (DMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:VITALYEVNA
Last Name:BEERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:VITALYEVNA
Other - Last Name:KOLPAKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3917 177TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7473
Mailing Address - Country:US
Mailing Address - Phone:503-539-7941
Mailing Address - Fax:
Practice Address - Street 1:12138 MUKILTEO SPEEDWAY UNIT 301
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5738
Practice Address - Country:US
Practice Address - Phone:425-347-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE611852011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice