Healthcare Provider Details

I. General information

NPI: 1700922812
Provider Name (Legal Business Name): DEEANN KUCERA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W STATE HIGHWAY 6 STE D
WACO TX
76710-5584
US

IV. Provider business mailing address

331 W STATE HIGHWAY 6 STE D
WACO TX
76710-5584
US

V. Phone/Fax

Practice location:
  • Phone: 254-772-0373
  • Fax: 254-772-4850
Mailing address:
  • Phone: 254-772-0373
  • Fax: 254-772-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15576
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: