Healthcare Provider Details

I. General information

NPI: 1922208867
Provider Name (Legal Business Name): REBECCA JOHNSON KUCERA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 N JEFFERSON ST
LEWISBURG WV
24901-1187
US

IV. Provider business mailing address

1489 N JEFFERSON ST
LEWISBURG WV
24901-1187
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-0251
  • Fax: 304-645-0252
Mailing address:
  • Phone: 304-645-0251
  • Fax: 304-645-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3783
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: