Provider Demographics
NPI:1295902849
Name:KOWALSKI, CHESTER EDWARD (DMD)
Entity type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:EDWARD
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PEMBROKE HILL
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-324-2694
Mailing Address - Fax:860-678-8922
Practice Address - Street 1:2 PEMBROKE HILL
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-324-2694
Practice Address - Fax:860-678-8922
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4956DENTIST122300000X
CT49561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist