Provider Demographics
NPI:1740451509
Name:DENTAL GROUP OF PAWTUCKET
Entity type:Organization
Organization Name:DENTAL GROUP OF PAWTUCKET
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:V
Authorized Official - Last Name:DULALA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DMD
Authorized Official - Phone:401-722-3344
Mailing Address - Street 1:1571 NEWPORT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-1351
Mailing Address - Country:US
Mailing Address - Phone:401-722-3344
Mailing Address - Fax:401-725-9755
Practice Address - Street 1:1571 NEWPORT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-1351
Practice Address - Country:US
Practice Address - Phone:401-722-3344
Practice Address - Fax:401-725-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty