Provider Demographics
NPI:1639501117
Name:TUM, SOMONKUL ALEXANDER (DMD)
Entity Type:Individual
Prefix:
First Name:SOMONKUL
Middle Name:ALEXANDER
Last Name:TUM
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 1:817 E LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-1211
Mailing Address - Country:US
Mailing Address - Phone:330-868-5001
Mailing Address - Fax:
Practice Address - Street 1:817 E LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-1211
Practice Address - Country:US
Practice Address - Phone:330-868-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63792122300000X
OH30024638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist