Healthcare Provider Details

I. General information

NPI: 1124450705
Provider Name (Legal Business Name): AMBEREEN FATIMA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FNU AMBEREEN FATIMA DDS

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAPLE ST STE 100
MARLBOROUGH MA
01752-3231
US

IV. Provider business mailing address

340 MAPLE ST STE 100
MARLBOROUGH MA
01752-3231
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-0110
  • Fax: 508-481-7110
Mailing address:
  • Phone: 508-481-0110
  • Fax: 508-481-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1856412
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: