Provider Demographics
NPI:1972657070
Name:KULESA, JON ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:ANDREW
Last Name:KULESA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W PECKHAM LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5402
Mailing Address - Country:US
Mailing Address - Phone:775-826-7600
Mailing Address - Fax:775-826-5608
Practice Address - Street 1:315 W PECKHAM LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5402
Practice Address - Country:US
Practice Address - Phone:775-826-7600
Practice Address - Fax:775-826-5608
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4840T122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist