Provider Demographics
NPI:1336265214
Name:BAWA, AMBREEN A (DDS)
Entity type:Individual
Prefix:DR
First Name:AMBREEN
Middle Name:A
Last Name:BAWA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-0344
Mailing Address - Country:US
Mailing Address - Phone:413-584-6275
Mailing Address - Fax:413-584-5938
Practice Address - Street 1:200 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035
Practice Address - Country:US
Practice Address - Phone:413-584-6275
Practice Address - Fax:413-584-5938
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223311223G0001X
RIDEN03065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice