Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 12978 | MA |
NPI | 1225013220 |
---|---|
Provider Name | Dr. Donald Eugene Kowalski |
First Address | Beverly, MA 01915-0896 |
Second Address | Beverly, MA 01915-4417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0246433 | (05) | MA |
979617 | UNITED CONCORDIA (01) | |
X11646 | BCBS (01) | MA |