Provider Demographics
NPI:1780885186
Name:NOWAKOWSKI, MARTIN P (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:P
Last Name:NOWAKOWSKI
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:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-0209
Mailing Address - Country:US
Mailing Address - Phone:410-987-1600
Mailing Address - Fax:
Practice Address - Street 1:8338 VETERANS HWY STE 203A
Practice Address - Street 2:SEVERN PROFESSIONAL BUILDING
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2636
Practice Address - Country:US
Practice Address - Phone:410-987-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD52251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice