Healthcare Provider Details

I. General information

NPI: 1104994656
Provider Name (Legal Business Name): KATHERINE ANNE KUCERA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 MORGAN RD
CERES CA
95307
US

IV. Provider business mailing address

3507 MORGAN RD
CERES CA
95307
US

V. Phone/Fax

Practice location:
  • Phone: 209-537-4673
  • Fax:
Mailing address:
  • Phone: 209-537-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: