| Doctor Name: | MR. KEVIN C KOWALSKI |
| NPI Number: | 1306048111 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.D. |
| License Number: | 0254 |
| Business Practice Address: | 1521 Leigh Way Suite A Mount Vernon, WA - 982732403 |
| Business Phone Number: | 3608487614 |
| Business Fax Number: | 3608486355 |
| Mailing Address: | 1521 Leigh Way, Suite A MOUNT VERNON |
| State: | WA |
| Postal Code: | 982732403 |
| Phone Number: | 3608487614 |
| Fax Number: | 3608486355 |
| NPI Enumeration Date: | 06/04/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | 0254 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |