Provider Demographics
NPI:1467681908
Name:RAWAL, KADAMBARI D (DDS)
Entity Type:Individual
Prefix:DR
First Name:KADAMBARI
Middle Name:D
Last Name:RAWAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 E NEWTON ST FL 7
Mailing Address - Street 2:BOSTON UNIVERSITY, DENTAL HEALTH CARE CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:201-918-0907
Mailing Address - Fax:
Practice Address - Street 1:100 E NEWTON ST FL 7
Practice Address - Street 2:BOSTON UNIVERSITY, DENTAL HEALTH CARE CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:201-918-0907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL106361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice