Provider Demographics
NPI:1972995827
Name:ALYSSA M. KOWALSKI D.D.S. INC.
Entity Type:Organization
Organization Name:ALYSSA M. KOWALSKI D.D.S. INC.
Other - Org Name:WILLOWICK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-944-3575
Mailing Address - Street 1:250 E 312TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3623
Mailing Address - Country:US
Mailing Address - Phone:440-944-3575
Mailing Address - Fax:
Practice Address - Street 1:250 E 312TH ST
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-3623
Practice Address - Country:US
Practice Address - Phone:440-944-3575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.232451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty