Provider Demographics
NPI:1023547718
Name:GORGULU, ANYA WOLFE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANYA
Middle Name:WOLFE
Last Name:GORGULU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANYA
Other - Middle Name:K
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:109 SUMMER ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-3538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 SUMMER ST STE 4
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3538
Practice Address - Country:US
Practice Address - Phone:802-885-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1857890122300000X
VT016.0133910122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist