Healthcare Provider Details

I. General information

NPI: 1538844238
Provider Name (Legal Business Name): ANNA YERMOLAYEVA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 DEERECO RD STE 204
TIMONIUM MD
21093-2122
US

IV. Provider business mailing address

6953 10 TIMBERS LN
BALTIMORE MD
21209-1635
US

V. Phone/Fax

Practice location:
  • Phone: 410-628-0677
  • Fax:
Mailing address:
  • Phone: 443-986-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number18793
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: