Provider Demographics
NPI:1811678063
Name:ATHANSIOS, ANNEMARIE O (DMD)
Entity type:Individual
Prefix:DR
First Name:ANNEMARIE
Middle Name:O
Last Name:ATHANSIOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VOLHA
Other - Middle Name:
Other - Last Name:BORTNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 DOMINICK CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1332
Mailing Address - Country:US
Mailing Address - Phone:646-330-1524
Mailing Address - Fax:
Practice Address - Street 1:2 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-2208
Practice Address - Country:US
Practice Address - Phone:973-239-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028175001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics