Provider Demographics
NPI:1780051318
Name:SHAGHARYAN, ANNA (DMD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SHAGHARYAN
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 1:6420 MEDICAL CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2446
Mailing Address - Country:US
Mailing Address - Phone:702-858-6815
Mailing Address - Fax:
Practice Address - Street 1:6420 MEDICAL CENTER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2446
Practice Address - Country:US
Practice Address - Phone:800-797-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV66461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice