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General NPI Number Information
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NPI Number | 1922436989
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Entity Type | Organization
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Legal Business Name | RAHUL A. DATAR, DMD, PLCC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 232 POND ST 2ND FLOOR
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City | NATICK
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State | MA
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Zip | 01760-4366
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Country | US
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Telephone | 508-318-6333
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Fax | 508-318-6338
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Provider Business Mailing Address
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Address Line | 232 POND ST 2ND FLOOR
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City | NATICK
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State | MA
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Zip | 01760-4366
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAHUL A DATAR
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Credential | DMD
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Telephone | 508-318-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1855631
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License Number State | MA
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