Provider Demographics
NPI:1013932805
Name:KASIMER KOWALSKI DMD PC
Entity Type:Organization
Organization Name:KASIMER KOWALSKI DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SEBASTIAN
Authorized Official - Last Name:GORACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-289-4848
Mailing Address - Street 1:477 CONNECTICUT BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3228
Mailing Address - Country:US
Mailing Address - Phone:860-289-4848
Mailing Address - Fax:860-289-3798
Practice Address - Street 1:477 CONNECTICUT BLVD STE 106
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3228
Practice Address - Country:US
Practice Address - Phone:860-289-4848
Practice Address - Fax:860-289-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT40011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22922Medicare UPIN