MEDICARE: TUMMINIA DENTAL ASSOCIATES

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
1	1223G0001X	General Practice Dentistry	DN 15196	FL

General Provider Information

NPI Number	:	1821221094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUMMINIA DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	7730 BOYNTON BEACH BLVD
Second Line	:	STE 6
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6155
Country	:	US
Telephone Number	:	561-736-1900
Fax Number	:	561-736-1966

Provider Business Practice Location Address
First Line	:	7730 BOYNTON BEACH BLVD
Second Line	:	STE 6
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6155
Country	:	US
Telephone Number	:	561-736-1900
Fax Number	:	561-736-1966

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATHRYN E. KOLOVANI-TUMMINIA
Credential	:	D.M.D.
Telephone Number	:	561-736-1900

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/03/2009

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1992143465 — ROBYN SANTIAGO FNP-BC
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