Provider Demographics
NPI:1154737583
Name:VAYSMAN, ANNA (DMD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VAYSMAN
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 1:9755 N 90TH ST STE 190
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5047
Mailing Address - Country:US
Mailing Address - Phone:480-451-0908
Mailing Address - Fax:
Practice Address - Street 1:9755 N 90TH ST STE 190
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5047
Practice Address - Country:US
Practice Address - Phone:480-451-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8989122300000X
AZ0089891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentist