Provider Demographics
NPI:1568575207
Name:TUMILOWICZ, KRISTOFFER JAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTOFFER
Middle Name:JAN
Last Name:TUMILOWICZ
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 1:1619 NORTH ALPINE ROAD
Mailing Address - Street 2:EDGEBROOK CENTER
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1414
Mailing Address - Country:US
Mailing Address - Phone:815-229-3520
Mailing Address - Fax:815-229-1456
Practice Address - Street 1:1619 NORTH ALPINE ROAD
Practice Address - Street 2:EDGEBROOK CENTER
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1414
Practice Address - Country:US
Practice Address - Phone:815-229-3520
Practice Address - Fax:815-229-1456
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A16048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist