Provider Demographics
NPI:1861584575
Name:TUMENIUK, ALEXANDER (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:TUMENIUK
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 1:345 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2528
Mailing Address - Country:US
Mailing Address - Phone:203-799-3693
Mailing Address - Fax:203-877-6159
Practice Address - Street 1:345 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2528
Practice Address - Country:US
Practice Address - Phone:203-876-2696
Practice Address - Fax:203-877-6159
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0074231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1367911Medicare UPIN