Provider Demographics
NPI:1285767632
Name:KOWALCZYK, STEPHEN J (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:KOWALCZYK
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 1:15 LAMBERT RDG
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518-1123
Mailing Address - Country:US
Mailing Address - Phone:203-743-9943
Mailing Address - Fax:
Practice Address - Street 1:57 NORTH ST STE 121
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5626
Practice Address - Country:US
Practice Address - Phone:203-744-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT91221223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT202463884OtherTIN