Healthcare Provider Details

I. General information

NPI: 1275106809
Provider Name (Legal Business Name): MICHAEL PLONSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 03/07/2023
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 RL THORNTON FWY
DALLAS TX
75203
US

IV. Provider business mailing address

3724 AVENUE T
BROOKLYN NY
11234-4932
US

V. Phone/Fax

Practice location:
  • Phone: 214-730-6335
  • Fax:
Mailing address:
  • Phone: 347-962-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN25992
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37850
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: