Provider Demographics
NPI:1427381243
Name:JUCAN, ADINA (DDS)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:JUCAN
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:EASTMAN DENTAL CENTER DCBO
Mailing Address - Street 2:625 ELMWOOD AVE BOX 683
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2913
Mailing Address - Country:US
Mailing Address - Phone:585-758-0969
Mailing Address - Fax:585-475-9265
Practice Address - Street 1:1101 ENGLISH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-2060
Practice Address - Country:US
Practice Address - Phone:585-227-4900
Practice Address - Fax:585-225-7073
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562361223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY056236OtherLICENSE