Provider Demographics
NPI:1821105917
Name:DUKOVICH, RICHARD A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:DUKOVICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 LIBRARY RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2946
Mailing Address - Country:US
Mailing Address - Phone:412-831-3853
Mailing Address - Fax:412-831-7425
Practice Address - Street 1:4880 LIBRARY RD
Practice Address - Street 2:SUITE F
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2946
Practice Address - Country:US
Practice Address - Phone:412-831-3853
Practice Address - Fax:412-831-7425
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025717-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172-4132OtherUNITED CONCORDIA