Provider Demographics
NPI:1114332269
Name:PLONSKI, STEPHANIE JEAN (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEAN
Last Name:PLONSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 MAIN ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1077
Mailing Address - Country:US
Mailing Address - Phone:413-733-6651
Mailing Address - Fax:413-733-6653
Practice Address - Street 1:1795 MAIN ST
Practice Address - Street 2:SUITE 216
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1077
Practice Address - Country:US
Practice Address - Phone:413-733-6651
Practice Address - Fax:413-733-6653
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18568571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004011136Medicaid