Provider Demographics
NPI:1861865149
Name:DAVE, RUPA (DDS)
Entity type:Individual
Prefix:DR
First Name:RUPA
Middle Name:
Last Name:DAVE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WESTFORD ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1506
Mailing Address - Country:US
Mailing Address - Phone:978-369-7967
Mailing Address - Fax:978-369-1086
Practice Address - Street 1:18 WESTFORD ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:MA
Practice Address - Zip Code:01741-1506
Practice Address - Country:US
Practice Address - Phone:978-369-7967
Practice Address - Fax:978-369-1086
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18570801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice