Provider Demographics
NPI:1619901501
Name:KUMAR, SATISH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SATISH
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6123
Mailing Address - Country:US
Mailing Address - Phone:928-819-8999
Mailing Address - Fax:928-539-5579
Practice Address - Street 1:801 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85349
Practice Address - Country:US
Practice Address - Phone:928-627-8584
Practice Address - Fax:928-627-8949
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447331806OtherCLINIC NPI
AZ019895Medicaid
1508947946OtherCLINIC NPI
1730278326OtherCLINIC NPI