Provider Demographics
NPI:1740377126
Name:KUECKELS, BRENDA LOUISE (DDS)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOUISE
Last Name:KUECKELS
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 1:1042 N MOUNTAIN AVE
Mailing Address - Street 2:SUITE B-111
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3695
Mailing Address - Country:US
Mailing Address - Phone:951-870-5531
Mailing Address - Fax:
Practice Address - Street 1:16455 MAIN ST
Practice Address - Street 2:#17
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3554
Practice Address - Country:US
Practice Address - Phone:760-244-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice