Provider Demographics
NPI:1780768366
Name:KAREN KUCHARSKI DMD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KAREN KUCHARSKI DMD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KUCHARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:530-546-5678
Mailing Address - Street 1:PO BOX 1947
Mailing Address - Street 2:8079 N LAKE BLVD #202
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143
Mailing Address - Country:US
Mailing Address - Phone:530-546-5678
Mailing Address - Fax:530-546-0467
Practice Address - Street 1:8079 NORTH LAKE BLVD
Practice Address - Street 2:#202
Practice Address - City:KINGS BEACH
Practice Address - State:CA
Practice Address - Zip Code:96143
Practice Address - Country:US
Practice Address - Phone:530-546-5678
Practice Address - Fax:530-546-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty