Healthcare Provider Details

I. General information

NPI: 1306959036
Provider Name (Legal Business Name): JOHN LOUIS TUMMINIA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 45TH ST
WEST PALM BEACH FL
33407-2361
US

IV. Provider business mailing address

8853 KETTLE DRUM TERRACE
BOYNTON BEACH FL
33437-4857
US

V. Phone/Fax

Practice location:
  • Phone: 561-514-5310
  • Fax:
Mailing address:
  • Phone: 561-244-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN16086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: