Provider Demographics
NPI:1033326996
Name:PONSKY, ROBERT MALCOLM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MALCOLM
Last Name:PONSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 KEELER RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:CT
Mailing Address - Zip Code:06752-1331
Mailing Address - Country:US
Mailing Address - Phone:860-350-4768
Mailing Address - Fax:
Practice Address - Street 1:12 SUNNY VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3323
Practice Address - Country:US
Practice Address - Phone:860-354-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist