Provider Demographics
NPI:1154639151
Name:KANUK, KATYA BRIANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATYA
Middle Name:BRIANNA
Last Name:KANUK
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:RAF LAKENHEATH 48 MDG/SGHC
Mailing Address - Street 2:BLDG 922, ROOM 220
Mailing Address - City:BRANDON
Mailing Address - State:SUFFOLK
Mailing Address - Zip Code:IP28 9PN
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RAF LAKENHEATH 48 MDG/SGHC
Practice Address - Street 2:BLDG 922, ROOM 220
Practice Address - City:BRANDON
Practice Address - State:SUFFOLK
Practice Address - Zip Code:IP28 9PN
Practice Address - Country:GB
Practice Address - Phone:01144163-852-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist