Provider Demographics
NPI:1538268255
Name:DATAR, RAHUL (DDS)
Entity type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:DATAR
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 1:191 SOCIAL STREET
Mailing Address - Street 2:THUNDERMIST HEALTH CENTER
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-0000
Mailing Address - Country:US
Mailing Address - Phone:617-669-3580
Mailing Address - Fax:401-235-6899
Practice Address - Street 1:191 SOCIAL ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3240
Practice Address - Country:US
Practice Address - Phone:401-767-4100
Practice Address - Fax:401-767-4165
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN03072122300000X
SC42411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist