=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295386688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVAN KOWALSKI DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2019
-----------------------------------------------------
Last Update Date | 10/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5901 KING HWY
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49048-6054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-344-4443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5901 KING HWY
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49048-6054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-344-4443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EVAN KOWALSKI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 810-623-2747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------