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General NPI Number Information
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NPI Number | 1285767632
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Entity Type | Individual
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Provider Name | STEPHEN J KOWALCZYK DDS
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Gender | Male
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 57 NORTH ST STE 121
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City | DANBURY
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State | CT
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Zip | 06810-5626
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Country | US
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Telephone | 203-744-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 15 LAMBERT RDG
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City | CROSS RIVER
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State | NY
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Zip | 10518-1123
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Country | US
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Telephone | 203-743-9943
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Fax |
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 9122
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License Number State | CT
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