Healthcare Provider Details

I. General information

NPI: 1699044305
Provider Name (Legal Business Name): KOWALSKI FAMILY DENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2011
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 CHANGEBRIDGE RD SUITE A2
MONTVILLE NJ
07045-9115
US

IV. Provider business mailing address

170 CHANGEBRIDGE RD SUITE A2
MONTVILLE NJ
07045-9115
US

V. Phone/Fax

Practice location:
  • Phone: 973-575-6100
  • Fax: 973-575-7772
Mailing address:
  • Phone: 973-575-6100
  • Fax: 973-575-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL15645
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HALINA B KOWALSKI
Title or Position: PRESIDENT
Credential: DMD
Phone: 973-575-6100