Healthcare Provider Details

I. General information

NPI: 1669784021
Provider Name (Legal Business Name): ALYSSA M KOWALSKI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E. 312TH ST.
WILLOWICK OH
44095
US

IV. Provider business mailing address

250 E. 312TH ST.
WILLOWICK OH
44095
US

V. Phone/Fax

Practice location:
  • Phone: 440-944-3575
  • Fax: 440-944-6849
Mailing address:
  • Phone: 440-944-3575
  • Fax: 440-944-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23245
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: