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General NPI Number Information
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NPI Number | 1699044305
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Entity Type | Organization
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Legal Business Name | KOWALSKI FAMILY DENTAL, P.C.
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Dates
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Enumeration Date | 12/26/2011
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 170 CHANGEBRIDGE RD SUITE A2
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City | MONTVILLE
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State | NJ
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Zip | 07045-9115
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Country | US
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Telephone | 973-575-6100
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Fax | 973-575-7772
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Provider Business Mailing Address
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Address Line | 170 CHANGEBRIDGE RD SUITE A2
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City | MONTVILLE
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State | NJ
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Zip | 07045-9115
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Country | US
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Telephone | 973-575-6100
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Fax | 973-575-7772
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HALINA B KOWALSKI
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Credential | DMD
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Telephone | 973-575-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DL15645
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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