Provider Demographics
NPI:1396879110
Name:KOWOLIK, JOAN ELIZABETH (BDS, LDS RCS,)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ELIZABETH
Last Name:KOWOLIK
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Gender:F
Credentials:BDS, LDS RCS,
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Mailing Address - Street 1:1121 W MICHIGAN ST
Mailing Address - Street 2:INDIANA UNIVERSITY SCHOOL OF DENTISTRY, DS 220G
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5211
Mailing Address - Country:US
Mailing Address - Phone:317-274-2794
Mailing Address - Fax:317-278-1438
Practice Address - Street 1:1121 W MICHIGAN ST
Practice Address - Street 2:INDIANA UNIVERSITY SCHOOL OF DENTISTRY, DS 220G
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5211
Practice Address - Country:US
Practice Address - Phone:317-274-2794
Practice Address - Fax:317-278-1438
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IN98000343A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry