Provider Demographics
NPI:1700144151
Name:TAMAKUWALA, JIGISHA JITESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIGISHA
Middle Name:JITESH
Last Name:TAMAKUWALA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WINDSOR HWY
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6908
Mailing Address - Country:US
Mailing Address - Phone:845-522-2609
Mailing Address - Fax:
Practice Address - Street 1:375 WINDSOR HWY
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7902
Practice Address - Country:US
Practice Address - Phone:845-565-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0569521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program