Healthcare Provider Details

I. General information

NPI: 1457423667
Provider Name (Legal Business Name): CHRISTOPHER KOWALSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 E NORTHWEST HWY
PALATINE IL
60074-6355
US

IV. Provider business mailing address

566 E NORTHWEST HWY
PALATINE IL
60074-6355
US

V. Phone/Fax

Practice location:
  • Phone: 847-202-0033
  • Fax: 847-202-0533
Mailing address:
  • Phone: 847-202-0033
  • Fax: 847-202-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019015652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: