Healthcare Provider Details

I. General information

NPI: 1225013220
Provider Name (Legal Business Name): DONALD EUGENE KOWALSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
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: 978-922-7364
Mailing address:
  • Phone: 978-927-5247
  • Fax: 978-922-7369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number12978
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: