Provider Demographics
NPI:1790924975
Name:KOWAL, RENEE A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:A
Last Name:KOWAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2249
Mailing Address - Country:US
Mailing Address - Phone:845-896-9820
Mailing Address - Fax:845-896-9822
Practice Address - Street 1:929 MAIN ST
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2249
Practice Address - Country:US
Practice Address - Phone:845-896-9820
Practice Address - Fax:845-896-9822
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051648-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice