Provider Demographics
NPI:1780944660
Name:KUKLERIS, DIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:KUKLERIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:KUKLERIENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1248 FM 78
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2465
Mailing Address - Country:US
Mailing Address - Phone:210-375-5256
Mailing Address - Fax:
Practice Address - Street 1:1248 FM 78
Practice Address - Street 2:SUITE 105
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2465
Practice Address - Country:US
Practice Address - Phone:210-375-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice