Provider Demographics
NPI:1760903355
Name:KACHULIS, VANESSA PAULA (DMD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:PAULA
Last Name:KACHULIS
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 1:1627 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6355
Mailing Address - Country:US
Mailing Address - Phone:412-977-1766
Mailing Address - Fax:
Practice Address - Street 1:340 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-1164
Practice Address - Country:US
Practice Address - Phone:724-794-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0413811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice