Provider Demographics
NPI:1962532903
Name:KONDOZSKI, ANA MARIA KONDOVSKI (DMD)
Entity type:Individual
Prefix:DR
First Name:ANA MARIA
Middle Name:KONDOVSKI
Last Name:KONDOZSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:M
Other - Last Name:BILLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1562 CONSTITUTION BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:803-324-7686
Mailing Address - Fax:803-324-5344
Practice Address - Street 1:1562 CONSTITUTION BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-324-7686
Practice Address - Fax:803-324-5344
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice