Provider Demographics
NPI:1447452388
Name:PONIATOWSKI, DEANNA M (DDS)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:M
Last Name:PONIATOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46600 ROMEO PLANK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5741
Mailing Address - Country:US
Mailing Address - Phone:586-226-9000
Mailing Address - Fax:586-226-3370
Practice Address - Street 1:46600 ROMEO PLANK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5741
Practice Address - Country:US
Practice Address - Phone:586-226-9000
Practice Address - Fax:586-226-3370
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice