Provider Demographics
NPI:1922436989
Name:RAHUL A. DATAR, DMD, PLCC
Entity Type:Organization
Organization Name:RAHUL A. DATAR, DMD, PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAHUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DATAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-318-6333
Mailing Address - Street 1:232 POND ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:232 POND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4366
Practice Address - Country:US
Practice Address - Phone:508-318-6333
Practice Address - Fax:508-318-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty