Provider Demographics
NPI:1316479959
Name:KUCKO, JENNIFER LINDSAY (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LINDSAY
Last Name:KUCKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 E CUMBERLAND AVE UNIT 2203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4261
Mailing Address - Country:US
Mailing Address - Phone:607-235-4430
Mailing Address - Fax:
Practice Address - Street 1:12113 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1732
Practice Address - Country:US
Practice Address - Phone:813-530-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL245161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program