Provider Demographics
NPI:1699848598
Name:KOWALEWSKI, JOANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:KOWALEWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4457
Mailing Address - Country:US
Mailing Address - Phone:718-417-8453
Mailing Address - Fax:718-417-1739
Practice Address - Street 1:6913 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4457
Practice Address - Country:US
Practice Address - Phone:718-417-8453
Practice Address - Fax:718-417-1739
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0462061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice