Healthcare Provider Details

I. General information

NPI: 1578691440
Provider Name (Legal Business Name): HALINA B KOWALSKI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 CHANGEBRIDGE RD SUITE A-2
MONTVILLE NJ
07045-9115
US

IV. Provider business mailing address

170 CHANGEBRIDGE RD SUITE A-2
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 TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI15645
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: