Provider Demographics
NPI:1689732505
Name:MICHAEL R TUMBARELLO DMD PA
Entity Type:Organization
Organization Name:MICHAEL R TUMBARELLO DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUMBARELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-619-4234
Mailing Address - Street 1:214 S CRUTCHFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27107-0765
Mailing Address - Country:US
Mailing Address - Phone:336-386-8251
Mailing Address - Fax:336-386-9773
Practice Address - Street 1:5569 OLD US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-6100
Practice Address - Country:US
Practice Address - Phone:336-619-4234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9006AOtherBCBS
979550OtherUNITED CONCORDIA