Provider Demographics
NPI:1396815312
Name:KOWALSKI, THOMAS ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
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 286
Mailing Address - Street 2:2 1/2 & MARKET STREETS
Mailing Address - City:BENTON
Mailing Address - State:PA
Mailing Address - Zip Code:17814
Mailing Address - Country:US
Mailing Address - Phone:570-925-6441
Mailing Address - Fax:570-925-5008
Practice Address - Street 1:2 & HALF & MARKET STREETS
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:PA
Practice Address - Zip Code:17814
Practice Address - Country:US
Practice Address - Phone:570-925-6441
Practice Address - Fax:570-925-5008
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020576L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice