Healthcare Provider Details

I. General information

NPI: 1902802010
Provider Name (Legal Business Name): MARIA KUMIK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA ROMANIAK DDS

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 WILLARD AVE. 3A
NEWINGTON CT
06111
US

IV. Provider business mailing address

485 WILLARD AVE. 3A
NEWINGTON CT
06111
US

V. Phone/Fax

Practice location:
  • Phone: 860-667-8777
  • Fax: 860-667-7773
Mailing address:
  • Phone: 860-667-8777
  • Fax: 860-667-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number008718
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: