Provider Demographics
NPI:1992744205
Name:CUCULICI, DANA B (DMD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:B
Last Name:CUCULICI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 EHRLICH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2005
Mailing Address - Country:US
Mailing Address - Phone:813-264-6911
Mailing Address - Fax:813-961-6338
Practice Address - Street 1:4917 EHRLICH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2005
Practice Address - Country:US
Practice Address - Phone:813-264-6911
Practice Address - Fax:813-961-6338
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL136671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice