1689732505 NPI number — MICHAEL R TUMBARELLO DMD PA

Table of content: (NPI 1689732505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689732505 NPI number — MICHAEL R TUMBARELLO DMD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL R TUMBARELLO DMD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689732505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 S CRUTCHFIELD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOBSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27107-0765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-386-8251
Provider Business Mailing Address Fax Number:
336-386-9773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5569 OLD US HIGHWAY 52
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27295-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-619-4234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TUMBARELLO
Authorized Official First Name:
ROBYN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
336-619-4234

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6885 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9006A . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 979550 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com