MEDICARE: DR. ANNA DALAVURAK DMD

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	122300000X	Dentist	19923	MA

General Provider Information

NPI Number	:	1376767384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA DALAVURAK DMD

Provider Business Mailing Address
First Line	:	779 WASHINGTON ST
Second Line	:	SUITE 3A-3C
City	:	CANTON
State	:	MA
Zip	:	02021-3022
Country	:	US
Telephone Number	:	781-828-8070
Fax Number	:	781-821-3490

Provider Business Practice Location Address
First Line	:	779 WASHINGTON ST
Second Line	:	SUITE 3A-3C
City	:	CANTON
State	:	MA
Zip	:	02021-3022
Country	:	US
Telephone Number	:	781-828-8070
Fax Number	:	781-821-3490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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