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General NPI Number Information
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NPI Number | 1447004452
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Entity Type | Organization
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Legal Business Name | PONKOWSKI FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 04/16/2024
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 39521 GARFIELD RD
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City | CLINTON TWP
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State | MI
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Zip | 48038-4300
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Country | US
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Telephone | 586-263-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 416 ORCHARDALE DR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-2246
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Country | US
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Telephone | 586-482-0175
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TIMOTHY JOSEPH PONKOWSKI JR.
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Credential | DDS
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Telephone | 313-820-7002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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