Provider Demographics
NPI:1538320122
Name:EDWARD J MICHALOWSKI DMD PC
Entity Type:Organization
Organization Name:EDWARD J MICHALOWSKI DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICHALOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-829-3698
Mailing Address - Street 1:1072 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1283
Mailing Address - Country:US
Mailing Address - Phone:508-829-3698
Mailing Address - Fax:508-829-5860
Practice Address - Street 1:1072 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1283
Practice Address - Country:US
Practice Address - Phone:508-829-3698
Practice Address - Fax:508-829-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty