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General NPI Number Information
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NPI Number | 1780885186
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Entity Type | Individual
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Provider Name | MARTIN P. NOWAKOWSKI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8338 VETERANS HWY STE 203A SEVERN PROFESSIONAL BUILDING
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City | MILLERSVILLE
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State | MD
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Zip | 21108-2636
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Country | US
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Telephone | 410-987-1600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 209
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City | MILLERSVILLE
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State | MD
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Zip | 21108-0209
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Country | US
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Telephone | 410-987-1600
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5225
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License Number State | MD
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