Provider Demographics
NPI:1932625217
Name:KUERNER, CYNTHIA (RDH, PHDHP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KUERNER
Suffix:
Gender:F
Credentials:RDH, PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16512-0369
Mailing Address - Country:US
Mailing Address - Phone:814-454-4530
Mailing Address - Fax:
Practice Address - Street 1:2120 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-3111
Practice Address - Country:US
Practice Address - Phone:814-464-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH071638124Q00000X
124Q00000X
PAPHDH000856124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPHDH000856OtherBUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS
PA103353787Medicaid
PADH071638OtherBUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS