Provider Demographics
NPI:1376767384
Name:DALAVURAK, ANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:DALAVURAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 WASHINGTON ST
Mailing Address - Street 2:SUITE 3A-3C
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3022
Mailing Address - Country:US
Mailing Address - Phone:781-828-8070
Mailing Address - Fax:781-821-3490
Practice Address - Street 1:779 WASHINGTON ST
Practice Address - Street 2:SUITE 3A-3C
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3022
Practice Address - Country:US
Practice Address - Phone:781-828-8070
Practice Address - Fax:781-821-3490
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist