Healthcare Provider Details

I. General information

NPI: 1982100319
Provider Name (Legal Business Name): ASHLEY ROSE KUKUNAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1789 S BRADDOCK AVE STE 110
PITTSBURGH PA
15218-1871
US

IV. Provider business mailing address

501 POINTE VIEW DR
MARS PA
16046-8906
US

V. Phone/Fax

Practice location:
  • Phone: 412-307-4496
  • Fax:
Mailing address:
  • Phone: 814-414-6729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS041732
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: