Provider Demographics
NPI:1982390100
Name:KOVECK FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:KOVECK FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOVECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-929-8160
Mailing Address - Street 1:2506 PENNINGTON PL
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9161
Mailing Address - Country:US
Mailing Address - Phone:219-929-8160
Mailing Address - Fax:
Practice Address - Street 1:534 N HALLECK ST
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-9553
Practice Address - Country:US
Practice Address - Phone:219-987-5733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty