Healthcare Provider Details

I. General information

NPI: 1144313453
Provider Name (Legal Business Name): MARK ALAN KOWAL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 S LIVERNOIS RD SUITE 275
ROCHESTER HILLS MI
48307-2584
US

IV. Provider business mailing address

441 S LIVERNOIS RD SUITE 275
ROCHESTER HILLS MI
48307-2584
US

V. Phone/Fax

Practice location:
  • Phone: 248-608-1300
  • Fax: 248-608-1303
Mailing address:
  • Phone: 248-608-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16451
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: