Provider Demographics
NPI:1932214301
Name:KROWICKI, CHARLES MORTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MORTON
Last Name:KROWICKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:63 MAIN STREET
Mailing Address - Street 2:PO BOX 545
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833
Mailing Address - Country:US
Mailing Address - Phone:908-537-2447
Mailing Address - Fax:908-236-7154
Practice Address - Street 1:63 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833
Practice Address - Country:US
Practice Address - Phone:908-236-2802
Practice Address - Fax:908-236-7154
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI010841001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics