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General NPI Number Information
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NPI Number | 1568575207
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Entity Type | Individual
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Provider Name | KRISTOFFER JAN TUMILOWICZ D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1619 NORTH ALPINE ROAD EDGEBROOK CENTER
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City | ROCKFORD
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State | IL
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Zip | 61107-1414
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Country | US
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Telephone | 815-229-3520
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Fax | 815-229-1456
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Provider Business Mailing Address
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Address Line | 1619 NORTH ALPINE ROAD EDGEBROOK CENTER
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City | ROCKFORD
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State | IL
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Zip | 61107-1414
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Country | US
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Telephone | 815-229-3520
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Fax | 815-229-1456
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 19A16048
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License Number State | IL
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