Provider Demographics
NPI:1619985710
Name:NOWAKOWSKI, RICHARD ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROY
Last Name:NOWAKOWSKI
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 1:3701 N EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5610
Mailing Address - Country:US
Mailing Address - Phone:765-288-2040
Mailing Address - Fax:
Practice Address - Street 1:3701 N EVERETT RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5610
Practice Address - Country:US
Practice Address - Phone:765-288-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008600A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist