Provider Demographics
NPI:1740974583
Name:TEMBHE, AMRITA
Entity type:Individual
Prefix:
First Name:AMRITA
Middle Name:
Last Name:TEMBHE
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 1:30 MORELAND ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1046 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:WEST BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7144
Practice Address - Country:US
Practice Address - Phone:617-331-0437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.01341721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice