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General NPI Number Information
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NPI Number | 1922790674
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Entity Type | Individual
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Provider Name | TUSHAR CHIMANBHAI THUMMAR DMD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 6790 W LAYTON AVE STE C
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City | GREENFIELD
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State | WI
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Zip | 53220-4571
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Country | US
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Telephone | 414-285-7929
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Fax |
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Provider Business Mailing Address
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Address Line | 7782 S DREXEL RIDGE WAY APT 105
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City | OAK CREEK
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State | WI
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Zip | 53154-4419
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Country | US
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Telephone | 551-216-7433
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Fax |
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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 | 6001165-15
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License Number State | WI
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