Healthcare Provider Details

I. General information

NPI: 1174454615
Provider Name (Legal Business Name): ANNA GUYUMDZHYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANAHIT ANNA VATIAN

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 6TH ST
DOVER NH
03820-5935
US

IV. Provider business mailing address

2 HAWTHORNE PL APT 14L
BOSTON MA
02114-2314
US

V. Phone/Fax

Practice location:
  • Phone: 603-272-6094
  • Fax:
Mailing address:
  • Phone: 425-301-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberWDL26940693B
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: