MEDICARE: DR. LALITHA SHANKAR DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	18910	MA

General Provider Information

NPI Number	:	1346390440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LALITHA SHANKAR DMD

Provider Business Mailing Address
First Line	:	101 PLEASANT ST
Second Line	:	SUITE #106
City	:	WORCESTER
State	:	MA
Zip	:	01609-3213
Country	:	US
Telephone Number	:	508-770-1451
Fax Number	:	508-770-1452

Provider Business Practice Location Address
First Line	:	101 PLEASANT ST
Second Line	:	SUITE #106
City	:	WORCESTER
State	:	MA
Zip	:	01609-3213
Country	:	US
Telephone Number	:	508-770-1451
Fax Number	:	508-770-1452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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