Healthcare Provider Details

I. General information

NPI: 1467130658
Provider Name (Legal Business Name): PAMELA KOWALIK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 W HILLSBORO BLVD STE C
DEERFIELD BEACH FL
33442-1114
US

IV. Provider business mailing address

2265 W HILLSBORO BLVD STE C
DEERFIELD BEACH FL
33442-1114
US

V. Phone/Fax

Practice location:
  • Phone: 954-427-2436
  • Fax:
Mailing address:
  • Phone: 773-659-9794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN28369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: