Provider Demographics
NPI:1316177892
Name:TUMENIUK, NATALIE (DMD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:TUMENIUK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:GALLUCCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21 WEST CLARK ST.
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-878-8548
Mailing Address - Fax:
Practice Address - Street 1:21 W CLARK ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2517
Practice Address - Country:US
Practice Address - Phone:203-878-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0074411223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice