Provider Demographics
NPI:1831244573
Name:NUCKLES, KATHLEEN J (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:J
Last Name:NUCKLES
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:10921 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3906
Mailing Address - Country:US
Mailing Address - Phone:310-208-8273
Mailing Address - Fax:310-208-0104
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1003
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3906
Practice Address - Country:US
Practice Address - Phone:310-208-8273
Practice Address - Fax:310-208-0104
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA299341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics