Healthcare Provider Details

I. General information

NPI: 1114610466
Provider Name (Legal Business Name): JOANNA KOWATLI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 DONOHOE DR
HUNTINGTON WV
25705-8887
US

IV. Provider business mailing address

3377 US - 60 DEPARTMENT I
HUNTINGTON WV
25705
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-3310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4808
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: