Provider Demographics
NPI:1316169790
Name:NOWACKI, CHRIS (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:NOWACKI
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 1:1202 MILLENNIUM PKWY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-3895
Mailing Address - Country:US
Mailing Address - Phone:813-653-1455
Mailing Address - Fax:813-653-3188
Practice Address - Street 1:1202 MILLENNIUM PKWY
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3895
Practice Address - Country:US
Practice Address - Phone:813-653-1455
Practice Address - Fax:813-653-3188
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist