Yelena Vladimirovna Gutnichenko, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20567 Issued in MA

Practice address

695 Main St
Waltham, MA 02451-0609

Phone

(781) 899-7070

Fax

(781) 899-1802

NPI assigned

Jul 3, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Dental of Waltham, P.C.

  • General Practice Dentistry
  • Waltham, MA
  • NPI 1184768426
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1174553481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 MAIN ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024510609",
            "telephone_number": "781-899-7070",
            "fax_number": "781-899-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 MAIN ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024510609",
            "telephone_number": "781-899-7070",
            "fax_number": "781-899-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTNICHENKO",
        "first_name": "YELENA",
        "middle_name": "VLADIMIROVNA",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "20567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0202576",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Arunika Gupta
• Tripti Gupta, DMD
• Aram Rees Gurekian, RPH
• Arianna Gurrera
• Irina A Guryanova, MD
• Karapet Guyumdzhyan, CRNA
• Jessica Hack-Chabot
• Mary E Hackel, NP-C
• John David Hackett, MD
• Kristen M. Haddon, DO

• General Practice Dentistry in Waltham, MA
• Providers in Waltham, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.