Provider Demographics
NPI:1194959858
Name:DEPOUNTI, ANASTASIA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:
Last Name:DEPOUNTI
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 1:50 FOX CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3024
Mailing Address - Country:US
Mailing Address - Phone:917-723-0925
Mailing Address - Fax:
Practice Address - Street 1:23 BOND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5805
Practice Address - Country:US
Practice Address - Phone:718-237-0222
Practice Address - Fax:718-522-1556
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053086122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist