Provider Demographics
NPI:1851020606
Name:KEITH D NOWICKI DDS PC
Entity Type:Organization
Organization Name:KEITH D NOWICKI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:NOWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-293-3633
Mailing Address - Street 1:32545 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-3843
Mailing Address - Country:US
Mailing Address - Phone:586-293-3633
Mailing Address - Fax:586-293-5683
Practice Address - Street 1:32545 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3843
Practice Address - Country:US
Practice Address - Phone:586-293-3633
Practice Address - Fax:586-293-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty