Provider Demographics
NPI:1720962004
Name:TUMUKUNTALA, SHIVANI (DDS)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:
Last Name:TUMUKUNTALA
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 1:15008 PIZARRO CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2499
Mailing Address - Country:US
Mailing Address - Phone:513-417-7668
Mailing Address - Fax:
Practice Address - Street 1:2891 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5382
Practice Address - Country:US
Practice Address - Phone:682-518-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX417451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice