Healthcare Provider Details

I. General information

NPI: 1669516993
Provider Name (Legal Business Name): YELENA V. GUTNICHENKO, DMD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 ELM ST
WALTHAM MA
02453-5317
US

IV. Provider business mailing address

52 ELM ST
WALTHAM MA
02453-5317
US

V. Phone/Fax

Practice location:
  • Phone: 781-899-9530
  • Fax: 781-736-0977
Mailing address:
  • Phone: 781-899-9530
  • Fax: 781-736-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. YELENA V GUTNICHENKO
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 781-899-9530