Provider Demographics
NPI:1629065420
Name:KUMAR, RENUKA PREM
Entity Type:Individual
Prefix:DR
First Name:RENUKA
Middle Name:PREM
Last Name:KUMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:RENUKA
Other - Middle Name:PREM
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9295 E THUNDERBIRD RD
Mailing Address - Street 2:#103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-4376
Mailing Address - Country:US
Mailing Address - Phone:480-767-6918
Mailing Address - Fax:480-767-7990
Practice Address - Street 1:9295 E THUNDERBIRD RD
Practice Address - Street 2:#103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-4376
Practice Address - Country:US
Practice Address - Phone:480-767-6918
Practice Address - Fax:480-767-7990
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113069Medicare UPIN