Individual
DR. ANASTASIA KHAITOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5645 MAIN ST, FLUSHING, NY 11355-5045
(718) 670-2000
Mailing address
17411 HORACE HARDING EXPY, FRESH MEADOWS, NY 11365-1527
(929) 402-0117
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
061113
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/31/2019
Last updated
10/14/2020
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