Provider Demographics
NPI:1265068530
Name:RAO, ANNE ISABELLE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ISABELLE
Last Name:RAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 IRVING ST APT 8
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3816
Mailing Address - Country:US
Mailing Address - Phone:978-289-2030
Mailing Address - Fax:
Practice Address - Street 1:793 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2736
Practice Address - Country:US
Practice Address - Phone:617-522-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL144361223G0001X
MADN18950401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice