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General NPI Number Information
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NPI Number | 1184834384
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Entity Type | Individual
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Provider Name | RICHARD M KELOWITZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 2165 NW 147TH ST
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City | NEWBERRY
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State | FL
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Zip | 32669-2043
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Country | US
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Telephone | 610-417-4130
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Fax |
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Provider Business Mailing Address
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Address Line | HEALTH SCIENCE CTR COLLEGE OF DENTISTRY
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City | GAINESVILLE
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State | FL
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Zip | 32610-0412
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Country | US
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Telephone | 610-691-6200
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Fax | 610-691-1840
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS020304L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN8554
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License Number State | FL
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