Provider Demographics
NPI:1174149363
Name:JUMONVILLE, NATALIYA PAVLOVNA (DMD)
Entity type:Individual
Prefix:DR
First Name:NATALIYA
Middle Name:PAVLOVNA
Last Name:JUMONVILLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 E BELL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6002
Mailing Address - Country:US
Mailing Address - Phone:602-996-2690
Mailing Address - Fax:602-996-4130
Practice Address - Street 1:4921 E BELL RD STE 108
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6002
Practice Address - Country:US
Practice Address - Phone:602-996-2690
Practice Address - Fax:602-996-4130
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA71071223G0001X
AZD0110451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice