Provider Demographics
NPI:1073600995
Name:RUMBOLO, CARLO (DMD)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:RUMBOLO
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 1:4329 CLEVELAND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9085
Mailing Address - Country:US
Mailing Address - Phone:239-936-6722
Mailing Address - Fax:
Practice Address - Street 1:4329 CLEVELAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9085
Practice Address - Country:US
Practice Address - Phone:239-936-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist