Provider Demographics
NPI:1174752018
Name:BUKOVCAN, PAOLA RODRIGUEZ (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:RODRIGUEZ
Last Name:BUKOVCAN
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:DR
Other - First Name:PAOLA
Other - Middle Name:RODRIGUEZ
Other - Last Name:HIGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD,MPH
Mailing Address - Street 1:1244 FORT WASHINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1244 FORT WASHINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1743
Practice Address - Country:US
Practice Address - Phone:215-643-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist