Basic Information
| Provider Information | |||||||||
| NPI: | 1154453298 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHATTACHARYA | ||||||||
| FirstName: | LALITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 42 PARK PLACE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017290080 | ||||||||
| FaxNumber: | 4017290438 | ||||||||
| Practice Location | |||||||||
| Address1: | 42 PARK PLACE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017295239 | ||||||||
| FaxNumber: | 4017290438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 08/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | RI 21-01 | RI | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 8399-1 | 01 | RI | BLUE CROSS ID | OTHER | LB 57712 | 01 | RI | MEDICAL ASSISTANCE | OTHER | RI 21-01 | 01 | RI | DELTA DENTAL ID | OTHER |