Provider Demographics
NPI:1790174043
Name:KUMFER FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:KUMFER FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUMFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-887-0700
Mailing Address - Street 1:521 E COUNTY LINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1065
Mailing Address - Country:US
Mailing Address - Phone:317-887-0700
Mailing Address - Fax:317-887-0701
Practice Address - Street 1:521 E COUNTY LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1065
Practice Address - Country:US
Practice Address - Phone:317-887-0700
Practice Address - Fax:317-887-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120117961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty