Individual
DR. WALTER JOSEPH KUCABA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
151 DILLON DR, SPARTANBURG, SC 29307-1017
(864) 585-0468
(864) 585-0469
Mailing address
151 DILLON DR, SPARTANBURG, SC 29307-1017
(864) 585-0468
(864) 585-0469
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
0218 PERIO
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0218 PERIO
SPECIALITY LICENSE
SC
Enumeration date
04/20/2006
Last updated
07/08/2007
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