Basic Information
| Provider Information | |||||||||
| NPI: | 1932625217 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUERNER | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RDH, PHDHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 369 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165120369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144544530 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2120 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165113111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144640307 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 02/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | DH071638 | PA | N | Dental Providers | Dental Hygienist | 124Q00000X | N | Dental Providers | Dental Hygienist | 124Q00000X | PHDH000856 | PA | Y | Dental Providers | Dental Hygienist |
ID Information
| ID | Type | State | Issuer | Description | PHDH000856 | 01 | PA | BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS | OTHER | 103353787 | 05 | PA | MEDICAID | DH071638 | 01 | PA | BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS | OTHER |