Provider Demographics
NPI:1619176435
Name:KUCERA, REBECCA M (DDS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:KUCERA
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 1:9075 TOWN CENTRE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4045
Mailing Address - Country:US
Mailing Address - Phone:440-838-1234
Mailing Address - Fax:440-838-0980
Practice Address - Street 1:9075 TOWN CENTRE DR STE 130
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-4045
Practice Address - Country:US
Practice Address - Phone:440-838-1234
Practice Address - Fax:440-838-0980
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022569122300000X
OH225691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist