Provider Demographics
NPI:1598982092
Name:RAO, LALITHA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LALITHA
Middle Name:R
Last Name:RAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 STONECREST PL
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4330
Mailing Address - Country:US
Mailing Address - Phone:909-874-7444
Mailing Address - Fax:909-874-7458
Practice Address - Street 1:1374 W FOOTHILL BLVD
Practice Address - Street 2:STE 'E'
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4621
Practice Address - Country:US
Practice Address - Phone:909-874-7444
Practice Address - Fax:909-874-7458
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG90794 -01OtherDENTICAL