Provider Demographics
NPI:1346925161
Name:RAO, TANYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:RAO
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 1:1682 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3456
Mailing Address - Country:US
Mailing Address - Phone:774-287-6129
Mailing Address - Fax:
Practice Address - Street 1:5 ENGLEWOOD ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-2048
Practice Address - Country:US
Practice Address - Phone:508-942-6908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist