Healthcare Provider Details

I. General information

NPI: 1184773525
Provider Name (Legal Business Name): MICHAEL KOWAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 REMSEN ST SUITE 1
COHOES NY
12047
US

IV. Provider business mailing address

129 REMSEN ST STE 1
COHOES NY
12047-2839
US

V. Phone/Fax

Practice location:
  • Phone: 518-237-3642
  • Fax: 518-237-8159
Mailing address:
  • Phone: 518-237-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39181
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: