Provider Demographics
NPI:1306058110
Name:AMITABHA LALA DDS PH.D
Entity type:Organization
Organization Name:AMITABHA LALA DDS PH.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:LALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PHD
Authorized Official - Phone:978-454-0977
Mailing Address - Street 1:517 ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-3826
Mailing Address - Country:US
Mailing Address - Phone:978-454-0977
Mailing Address - Fax:978-458-8776
Practice Address - Street 1:517 ROGERS ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-3826
Practice Address - Country:US
Practice Address - Phone:978-454-0977
Practice Address - Fax:978-458-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11622OtherBLUE CROSS BLUE SHIELD
MA9713247Medicare ID - Type Unspecified