MEDICARE: DR ANNA VISHART DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1629494992	OTHER	MA	NPI

General Provider Information

NPI Number	:	1265936371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ANNA VISHART DDS PLLC

Provider Business Mailing Address
First Line	:	418 WASHINGTON ST
Second Line	:
City	:	DEDHAM
State	:	MA
Zip	:	02026-4446
Country	:	US
Telephone Number	:	781-471-7934
Fax Number	:	781-686-9804

Provider Business Practice Location Address
First Line	:	418 WASHINGTON ST
Second Line	:
City	:	DEDHAM
State	:	MA
Zip	:	02026-4446
Country	:	US
Telephone Number	:	781-471-7934
Fax Number	:	781-686-9804

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANNA S VISHART
Credential	:	DDS
Telephone Number	:	781-471-7934

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	03/22/2018

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