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General NPI Number Information
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NPI Number | 1295148997
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Entity Type | Individual
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Provider Name | SMITA KUMAR
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Gender | Female
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 4915 WASHINGTON AVE STE B
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City | RACINE
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State | WI
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Zip | 53406-4221
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Country | US
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Telephone | 262-619-1949
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Fax | 877-335-3684
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Provider Business Mailing Address
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Address Line | 2572 S 76TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53219-2476
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Country | US
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Telephone | 414-306-6420
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Fax | 877-335-3684
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7260-15
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License Number State | WI
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