Provider Demographics
NPI:1588829980
Name:MASAITIS, ANITA MARIE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MARIE
Last Name:MASAITIS
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:PO BOX 40760
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274
Mailing Address - Country:US
Mailing Address - Phone:480-706-9430
Mailing Address - Fax:480-461-1785
Practice Address - Street 1:210 1ST ST
Practice Address - Street 2:WANBLEE HEALTH CENTER
Practice Address - City:WANBLEE
Practice Address - State:SD
Practice Address - Zip Code:57577
Practice Address - Country:US
Practice Address - Phone:605-462-5630
Practice Address - Fax:605-462-6631
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0101177122300000X
MT2302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT016.0101177OtherDENTAL LICENSE
MT2302OtherLICENSE