Healthcare Provider Details

I. General information

NPI: 1598218596
Provider Name (Legal Business Name): YURIY KUCHMAK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2996 EXECUTIVE DRIVE UNIT 102
VENICE FL
34292
US

IV. Provider business mailing address

2996 EXECUTIVE DRIVE UNIT 102
VENICE FL
34292
US

V. Phone/Fax

Practice location:
  • Phone: 941-477-1620
  • Fax: 941-477-1623
Mailing address:
  • Phone: 941-477-1620
  • Fax: 941-477-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN21932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: