Provider Demographics
NPI:1497912182
Name:KOWALSKI, KENNETH F (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:F
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARK PL
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1403
Mailing Address - Country:US
Mailing Address - Phone:860-225-5555
Mailing Address - Fax:860-827-9124
Practice Address - Street 1:6 PARK PL
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1403
Practice Address - Country:US
Practice Address - Phone:860-225-5555
Practice Address - Fax:860-827-9124
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist