Healthcare Provider Details

I. General information

NPI: 1427574482
Provider Name (Legal Business Name): EVAN JOSEPH KOWALSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 10/27/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 KING HWY
KALAMAZOO MI
49048-6054
US

IV. Provider business mailing address

5901 KING HWY
KALAMAZOO MI
49048-6054
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-4443
  • Fax:
Mailing address:
  • Phone: 269-344-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901022434
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: