Provider Demographics
NPI:1982790333
Name:MICHAEL KOWALIK DDS LTD
Entity type:Organization
Organization Name:MICHAEL KOWALIK DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KOWALIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-599-3333
Mailing Address - Street 1:6320 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1161
Mailing Address - Country:US
Mailing Address - Phone:708-599-3333
Mailing Address - Fax:708-599-1017
Practice Address - Street 1:6320 W 79TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1161
Practice Address - Country:US
Practice Address - Phone:708-599-3333
Practice Address - Fax:708-599-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A146021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty