Healthcare Provider Details

I. General information

NPI: 1316202377
Provider Name (Legal Business Name): MICHAEL JOSEPH KOWALCZYK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N ELM ST STE 230
HINSDALE IL
60521-3684
US

IV. Provider business mailing address

911 N ELM ST STE 230
HINSDALE IL
60521-3684
US

V. Phone/Fax

Practice location:
  • Phone: 630-323-4468
  • Fax:
Mailing address:
  • Phone: 630-323-4468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1074
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.029356
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: