MEDICARE: KAREN KUCHARSKI DMD A PROFESSIONAL CORPORATION

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	1223G0001X	General Practice Dentistry	46087	CA

General Provider Information

NPI Number	:	1780768366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN KUCHARSKI DMD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 1947
Second Line	:	8079 N LAKE BLVD #202
City	:	KINGS BEACH
State	:	CA
Zip	:	96143
Country	:	US
Telephone Number	:	530-546-5678
Fax Number	:	530-546-0467

Provider Business Practice Location Address
First Line	:	8079 NORTH LAKE BLVD
Second Line	:	#202
City	:	KINGS BEACH
State	:	CA
Zip	:	96143
Country	:	US
Telephone Number	:	530-546-5678
Fax Number	:	530-546-0467

Authorized Official
Title or Position	:	DENTIST
Name	:	KAREN LYNN KUCHARSKI
Credential	:	DMD
Telephone Number	:	530-546-5678

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/05/2008

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