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NPI Code Detail

MEDICARE: DR. HARISH TUMMALA MD, DMD

MEDICARE: DR. HARISH TUMMALA MD, DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)DN24898FL
21223S0112XOral and Maxillofacial Surgery (Dentist)7401LA

General Provider Information

NPI Number : 1023632098
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HARISH TUMMALA MD, DMD
Provider Business Mailing Address
First Line : 9108 HEARTH LN
Second Line :
City : SHREVEPORT
State : LA
Zip : 71129-4605
Country : US
Telephone Number : 304-890-0118
Fax Number :
Provider Business Practice Location Address
First Line : 385 BERT KOUNS INDUSTRIAL LOOP
Second Line :
City : SHREVEPORT
State : LA
Zip : 71106-8158
Country : US
Telephone Number : 318-524-7736
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2020
Last Update Date : 06/23/2026

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