Provider Demographics
NPI:1588768600
Name:TUMBARELLO, MICHAEL RAYMOND (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:TUMBARELLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5569 OLD US HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-6100
Mailing Address - Country:US
Mailing Address - Phone:336-619-4234
Mailing Address - Fax:
Practice Address - Street 1:5569 OLD US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295
Practice Address - Country:US
Practice Address - Phone:336-619-4234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9006AOtherBLUE CROSS BLUE SHIELD