Provider Demographics
NPI:1679293997
Name:RAO, NAMAN RAJESHKUMAR (DMD, MMSC)
Entity type:Individual
Prefix:DR
First Name:NAMAN RAJESHKUMAR
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 PARK AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-2654
Mailing Address - Country:US
Mailing Address - Phone:201-913-4129
Mailing Address - Fax:
Practice Address - Street 1:130 WATER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5478
Practice Address - Country:US
Practice Address - Phone:978-342-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist