Provider Demographics
NPI:1336591577
Name:MARTI BAGDASAROV, ANJELIKA (DMD)
Entity Type:Individual
Prefix:
First Name:ANJELIKA
Middle Name:
Last Name:MARTI BAGDASAROV
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANJELIKA
Other - Middle Name:
Other - Last Name:MARTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:47 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4672
Mailing Address - Country:US
Mailing Address - Phone:863-452-3060
Mailing Address - Fax:
Practice Address - Street 1:1514 1ST ST N
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2476
Practice Address - Country:US
Practice Address - Phone:863-292-4280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN219301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice