Healthcare Provider Details

I. General information

NPI: 1285767632
Provider Name (Legal Business Name): STEPHEN J KOWALCZYK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 NORTH ST STE 121
DANBURY CT
06810-5626
US

IV. Provider business mailing address

15 LAMBERT RDG
CROSS RIVER NY
10518-1123
US

V. Phone/Fax

Practice location:
  • Phone: 203-744-7310
  • Fax:
Mailing address:
  • Phone: 203-743-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number9122
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: