MEDICARE: ANNA DALAVURAK DMD, PC

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	1223G0001X	General Practice Dentistry	19923	MA

General Provider Information

NPI Number	:	1245454289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNA DALAVURAK DMD, PC

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	:
Fax Number	:

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	:	DENTIST
Name	:	DR. ANNA DALAVURAK
Credential	:	DMD
Telephone Number	:	781-828-8070

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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