Provider Demographics
NPI:1689869398
Name:FURMAN, TATYANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:
Last Name:FURMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TATYANA
Other - Middle Name:
Other - Last Name:BULKANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 N WILSON RD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160
Mailing Address - Country:US
Mailing Address - Phone:270-352-4343
Mailing Address - Fax:270-352-2323
Practice Address - Street 1:309 N WILSON RD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160
Practice Address - Country:US
Practice Address - Phone:270-352-4343
Practice Address - Fax:270-352-2323
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012060A122300000X
KY8518122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1689869398Medicaid
IN1689869398Medicaid