Healthcare Provider Details

I. General information

NPI: 1063359578
Provider Name (Legal Business Name): FNU NAIMA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 REVERE BEACH PKWY
EVERETT MA
02149-5912
US

IV. Provider business mailing address

1795 REVERE BEACH PKWY
EVERETT MA
02149-5912
US

V. Phone/Fax

Practice location:
  • Phone: 617-294-2600
  • Fax:
Mailing address:
  • Phone: 617-294-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10001549
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: