Healthcare Provider Details

I. General information

NPI: 1053224386
Provider Name (Legal Business Name): JESSICA KUCERA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S 40TH ST STE 28
LINCOLN NE
68506-5243
US

IV. Provider business mailing address

1919 S 40TH ST STE 28
LINCOLN NE
68506-5243
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-1054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3186
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: