Organization
RANDY J KOVICAK, DDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW MATTA (OWNER)
(231) 739-1300
Entity
Organization
Contact information
Practice address
935 W NORTON AVE STE B, NORTON SHORES, MI 49441-4195
(231) 739-1300
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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