Provider Demographics
NPI:1972723930
Name:RICHARD R. NOWAKOWSKI, DDS, LLC
Entity Type:Organization
Organization Name:RICHARD R. NOWAKOWSKI, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:NOWAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-288-2040
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:765-288-2074
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:765-288-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008600A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty