Healthcare Provider Details

I. General information

NPI: 1629794987
Provider Name (Legal Business Name): ASHOT HOVHANNISYAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 HOLIDAY DR STE 1
RUTLAND VT
05701-4889
US

IV. Provider business mailing address

474 HOLIDAY DR STE 1
RUTLAND VT
05701-4889
US

V. Phone/Fax

Practice location:
  • Phone: 305-699-4488
  • Fax:
Mailing address:
  • Phone: 305-699-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN27571
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number016.0134279
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: