Provider Demographics
NPI:1841330404
Name:LALL, DEORAJ RAVI (DDS)
Entity type:Individual
Prefix:DR
First Name:DEORAJ
Middle Name:RAVI
Last Name:LALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14357 LAKE PICKETT RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3444
Mailing Address - Country:US
Mailing Address - Phone:407-733-6146
Mailing Address - Fax:
Practice Address - Street 1:114 TIMBERLACHEN CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3395
Practice Address - Country:US
Practice Address - Phone:407-330-3801
Practice Address - Fax:407-330-5739
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN15198OtherDENTAL LICENSE NUMBER