Individual
DR. RYAN M KOWALCZYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1625 W BANNOCK ST, BOISE, ID 83702-5155
(208) 342-5444
(208) 342-2076
Mailing address
1625 W BANNOCK ST, BOISE, ID 83702-5155
(208) 890-1247
(208) 549-5988
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3689
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6P481
BLUE CROSS OF IDAHO
ID
Enumeration date
08/16/2006
Last updated
12/06/2023
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