Provider Demographics
NPI:1518663178
Name:BUMBURY, TAMEIKA (RDH)
Entity Type:Individual
Prefix:
First Name:TAMEIKA
Middle Name:
Last Name:BUMBURY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 20TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-4416
Mailing Address - Country:US
Mailing Address - Phone:646-203-9484
Mailing Address - Fax:
Practice Address - Street 1:472 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4004
Practice Address - Country:US
Practice Address - Phone:718-965-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11532124Q00000X
GADH043975124Q00000X
NY027983124Q00000X
CT8287124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist