Healthcare Provider Details

I. General information

NPI: 1528618782
Provider Name (Legal Business Name): DOLORES KOWALICK RDH, PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 E LINCOLN HWY
COATESVILLE PA
19320-3590
US

IV. Provider business mailing address

882 SPRUCE CIRCLE
HARLEYSVILLE PA
19438
US

V. Phone/Fax

Practice location:
  • Phone: 610-380-4660
  • Fax:
Mailing address:
  • Phone: 267-664-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH070168
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: