Provider Demographics
NPI:1003912791
Name:TUMMILLO, JEROME (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:TUMMILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 BERWYN COURT
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4672
Mailing Address - Country:US
Mailing Address - Phone:856-751-0864
Mailing Address - Fax:
Practice Address - Street 1:531 ROUTE 22 EAST
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889
Practice Address - Country:US
Practice Address - Phone:908-534-4001
Practice Address - Fax:908-534-2937
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI01790300122300000X
PADS029630L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist