Provider Demographics
NPI:1629794987
Name:HOVHANNISYAN, ASHOT (DMD)
Entity type:Individual
Prefix:DR
First Name:ASHOT
Middle Name:
Last Name:HOVHANNISYAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 HOLIDAY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4889
Mailing Address - Country:US
Mailing Address - Phone:305-699-4488
Mailing Address - Fax:
Practice Address - Street 1:474 HOLIDAY DR STE 1
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4889
Practice Address - Country:US
Practice Address - Phone:305-699-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27571122300000X
VT016.0134279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist