Provider Demographics
NPI:1891013116
Name:MARU, AMI MAHENDRA (DMD)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:MAHENDRA
Last Name:MARU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SOLDIERS FIELD PARK
Mailing Address - Street 2:#14B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02163
Mailing Address - Country:US
Mailing Address - Phone:270-315-2858
Mailing Address - Fax:
Practice Address - Street 1:11 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4802
Practice Address - Country:US
Practice Address - Phone:617-484-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18588941223P0221X
GADN0144781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty