Provider Demographics
NPI:1902077761
Name:MARLBORO DMD GROUP
Entity Type:Organization
Organization Name:MARLBORO DMD GROUP
Other - Org Name:DENTAL GROUP OF MARLBORO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DULALA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS,DMD
Authorized Official - Phone:508-485-7000
Mailing Address - Street 1:19 MAPLE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2904
Mailing Address - Country:US
Mailing Address - Phone:508-485-7000
Mailing Address - Fax:
Practice Address - Street 1:19 MAPLE ST
Practice Address - Street 2:SUITE E
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2904
Practice Address - Country:US
Practice Address - Phone:508-485-7000
Practice Address - Fax:
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