Provider Demographics
NPI:1922619634
Name:GORITSKAIA, ANNA VALERIEVNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:VALERIEVNA
Last Name:GORITSKAIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 MISSION ST APT 2318
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-6757
Mailing Address - Country:US
Mailing Address - Phone:415-424-3961
Mailing Address - Fax:
Practice Address - Street 1:1188 MISSION ST APT 2318
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-6757
Practice Address - Country:US
Practice Address - Phone:415-424-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist