1073682548 NPI number — KOVAL DENTISTRY SERVICES, P.C.

Table of content: (NPI 1073682548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073682548 NPI number — KOVAL DENTISTRY SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOVAL DENTISTRY SERVICES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY DENTAL CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073682548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 CROSSROADS DR STE 216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-5481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-581-3012
Provider Business Mailing Address Fax Number:
410-581-3045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 CROSSROADS DR STE 216
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-5481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-581-3012
Provider Business Practice Location Address Fax Number:
410-581-3045
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHKOLNIK
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
410-581-3012

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6580 . This is a "DENTAL NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1803483 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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