Individual
KUMJOHN TANVISHUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5923 W FRIENDLY AVE, GREENSBORO, NC 27410-3207
(336) 632-0744
(336) 632-0754
Mailing address
PO BOX 2222, LILLINGTON, NC 27546-2222
(910) 893-1096
(910) 814-1559
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8689
NC
Other
Enumeration date
09/09/2008
Last updated
09/09/2008
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