Basic Information
| Provider Information | |||||||||
| NPI: | 1497019053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOVALSKI | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | D.M.D, | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 59 KOCH AVE | ||||||||
| Address2: | |||||||||
| City: | MORRIS PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079504400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735381800 | ||||||||
| FaxNumber: | 9738898481 | ||||||||
| Practice Location | |||||||||
| Address1: | 59 KOCH AVE | ||||||||
| Address2: | |||||||||
| City: | MORRIS PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079504400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735381800 | ||||||||
| FaxNumber: | 9738898481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2012 | ||||||||
| LastUpdateDate: | 06/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DI01617600 | NJ | Y | Dental Providers | Dentist |
No ID Information.