Provider Demographics
NPI:1538921143
Name:RAKESH, ELLORA
Entity type:Individual
Prefix:
First Name:ELLORA
Middle Name:
Last Name:RAKESH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CHATHAM WAY
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4100
Mailing Address - Country:US
Mailing Address - Phone:412-979-0890
Mailing Address - Fax:
Practice Address - Street 1:571 WORCESTER RD STE 5
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5370
Practice Address - Country:US
Practice Address - Phone:508-504-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN100009091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice