Provider Demographics
NPI:1225013220
Name:KOWALSKI, DONALD EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EUGENE
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3182
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-0896
Mailing Address - Country:US
Mailing Address - Phone:978-927-5247
Mailing Address - Fax:978-922-7369
Practice Address - Street 1:39 BROADWAY
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4417
Practice Address - Country:US
Practice Address - Phone:978-927-5247
Practice Address - Fax:978-922-7364
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129781223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11646OtherBCBS
MA0246433Medicaid
979617OtherUNITED CONCORDIA