Provider Demographics
NPI:1356917900
Name:VOYICH, NASTASSJA (DMD)
Entity type:Individual
Prefix:DR
First Name:NASTASSJA
Middle Name:
Last Name:VOYICH
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 1:825 VILLA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-3137
Mailing Address - Country:US
Mailing Address - Phone:970-620-0947
Mailing Address - Fax:
Practice Address - Street 1:200 W VICTORY WAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2704
Practice Address - Country:US
Practice Address - Phone:970-824-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002047331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty