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NPI Code Detail

MEDICARE: DR. GREGORY R KOWALCHUK DDS

MEDICARE: DR. GREGORY R KOWALCHUK DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry0237CO

General Provider Information

NPI Number : 1396730990
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY R KOWALCHUK DDS
Provider Business Mailing Address
First Line : 28666 LITTLE BIG HORN DR
Second Line :
City : EVERGREEN
State : CO
Zip : 80439-6314
Country : US
Telephone Number : 303-674-3486
Fax Number :
Provider Business Practice Location Address
First Line : 7515 W YALE AVE
Second Line : SUITE A
City : DENVER
State : CO
Zip : 80227-3423
Country : US
Telephone Number : 303-988-3319
Fax Number : 303-988-3492
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 07/08/2007

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