Provider Demographics
NPI:1861543233
Name:TUMALI -LEE, CHRISTINE M (DDS)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:TUMALI -LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:NUGROHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1049 E BROOKDALE PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3330
Mailing Address - Country:US
Mailing Address - Phone:714-879-9626
Mailing Address - Fax:714-828-3009
Practice Address - Street 1:135 S KNOTT AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1406
Practice Address - Country:US
Practice Address - Phone:714-527-2297
Practice Address - Fax:714-828-3009
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA341801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice