MEDICARE: REBECCA M KUCERA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30022569	OH
2	1223P0221X	Pediatric Dentistry	22569	OH

General Provider Information

NPI Number	:	1619176435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA M KUCERA DDS

Provider Business Mailing Address
First Line	:	9075 TOWN CENTRE DR STE 130
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-4045
Country	:	US
Telephone Number	:	440-838-1234
Fax Number	:	440-838-0980

Provider Business Practice Location Address
First Line	:	9075 TOWN CENTRE DR STE 130
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-4045
Country	:	US
Telephone Number	:	440-838-1234
Fax Number	:	440-838-0980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	03/11/2020

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