Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2001025879 | MO |
NPI | 1114090842 |
---|---|
Provider Name | Dr. William J Kowalski |
First Address | Fenton, MO 63026 |
Second Address | Fenton, MO 63026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |