Provider Demographics
NPI:1861684003
Name:OWENS, ANASTASIA LIANNE DODSON (DDS)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:LIANNE DODSON
Last Name:OWENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:LIANNE
Other - Last Name:DODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:601 W MOANA LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4955
Mailing Address - Country:US
Mailing Address - Phone:303-884-8101
Mailing Address - Fax:
Practice Address - Street 1:601 W MOANA LN
Practice Address - Street 2:SUITE 2
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4955
Practice Address - Country:US
Practice Address - Phone:775-825-8990
Practice Address - Fax:775-825-0936
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011095122300000X
CO9564122300000X
NV6054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist