Provider Demographics
NPI:1942539671
Name:HOME DENTAL SERVICES, LLC
Entity Type:Organization
Organization Name:HOME DENTAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-526-7739
Mailing Address - Street 1:2942 N 24TH ST
Mailing Address - Street 2:#114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7844
Mailing Address - Country:US
Mailing Address - Phone:303-526-7739
Mailing Address - Fax:
Practice Address - Street 1:2942 N 24TH ST
Practice Address - Street 2:#114
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7844
Practice Address - Country:US
Practice Address - Phone:303-526-7739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty