Healthcare Provider Details

I. General information

NPI: 1699172643
Provider Name (Legal Business Name): KOWALSKI DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 BROADWAY
BEVERLY MA
01915-4417
US

IV. Provider business mailing address

PO BOX 3182
BEVERLY MA
01915-0896
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-5247
  • Fax: 978-922-7369
Mailing address:
  • Phone: 978-927-5247
  • Fax: 978-922-7369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DAWNA KOWALSKI
Title or Position: PRESIDENT
Credential: DMD
Phone: 978-927-5247