Provider Demographics
NPI:1801936422
Name:KUCERA, RAYMOND PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:PAUL
Last Name:KUCERA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:PAUL
Other - Last Name:KUCERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:467 GIRARD ST
Mailing Address - Street 2:532 GOUCHER ST
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3321
Mailing Address - Country:US
Mailing Address - Phone:814-255-4690
Mailing Address - Fax:
Practice Address - Street 1:532 GOUCHER ST
Practice Address - Street 2:532 GOUCHER ST
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3348
Practice Address - Country:US
Practice Address - Phone:814-255-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0176261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice