Provider Demographics
NPI:1669219721
Name:CANTUMENJIVAR, KARINA (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:KARINA
Middle Name:
Last Name:CANTUMENJIVAR
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:DR
Other - First Name:MYRNA
Other - Middle Name:KARINA
Other - Last Name:GONZALEZCANTU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,MS
Mailing Address - Street 1:120 KINGSTON ST PH 2509
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2264
Mailing Address - Country:US
Mailing Address - Phone:956-607-2699
Mailing Address - Fax:
Practice Address - Street 1:1KNEELANDST
Practice Address - Street 2:PERIODONTICS
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program