Provider Demographics
NPI:1427128602
Name:NOWACKI, MARIA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:NOWACKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:NOWACKI- LIFSTED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:44 2ND STREET PIKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3830
Mailing Address - Country:US
Mailing Address - Phone:215-354-5544
Mailing Address - Fax:215-354-5566
Practice Address - Street 1:44 2ND STREET PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3830
Practice Address - Country:US
Practice Address - Phone:215-354-5544
Practice Address - Fax:215-354-5566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029385L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice