Healthcare Provider Details

I. General information

NPI: 1518663178
Provider Name (Legal Business Name): TAMEIKA BUMBURY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 5TH AVE
BROOKLYN NY
11215-4004
US

IV. Provider business mailing address

185 20TH ST APT 8
BROOKLYN NY
11232-4416
US

V. Phone/Fax

Practice location:
  • Phone: 718-965-1144
  • Fax:
Mailing address:
  • Phone: 646-203-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11532
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH043975
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number027983
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8287
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: