Provider Demographics
NPI:1699219709
Name:KUMAR, TANAYA
Entity Type:Individual
Prefix:
First Name:TANAYA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712, 174 AVE NE.
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:832-853-9452
Mailing Address - Fax:
Practice Address - Street 1:4901 POINT FOSDICK DR. NW STREET 300
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:313-494-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE607301751223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics