Provider Demographics
NPI:1447004452
Name:PONKOWSKI FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:PONKOWSKI FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PONKOWSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-820-7002
Mailing Address - Street 1:416 ORCHARDALE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2246
Mailing Address - Country:US
Mailing Address - Phone:586-482-0175
Mailing Address - Fax:
Practice Address - Street 1:39521 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-4300
Practice Address - Country:US
Practice Address - Phone:586-263-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental