Provider Demographics
NPI:1295453884
Name:TUFO, KENAN (DMD)
Entity type:Individual
Prefix:DR
First Name:KENAN
Middle Name:
Last Name:TUFO
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 1:905 S CAN DOTA AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-4202
Mailing Address - Country:US
Mailing Address - Phone:773-809-0409
Mailing Address - Fax:
Practice Address - Street 1:2900 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1000
Practice Address - Country:US
Practice Address - Phone:847-577-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019033798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist