Provider Demographics
NPI:1184773525
Name:KOWAL, MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KOWAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 REMSEN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2839
Mailing Address - Country:US
Mailing Address - Phone:518-237-3642
Mailing Address - Fax:
Practice Address - Street 1:139 REMSEN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047
Practice Address - Country:US
Practice Address - Phone:518-237-3642
Practice Address - Fax:518-237-8159
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000460416001OtherBLUE SHIELD NEWY
NY00895116Medicaid