Provider Demographics
NPI:1457484941
Name:POGONCHEFF, METODI C (DDS)
Entity Type:Individual
Prefix:DR
First Name:METODI
Middle Name:C
Last Name:POGONCHEFF
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 1:2628 LAKE LANSING RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3668
Mailing Address - Country:US
Mailing Address - Phone:517-482-5636
Mailing Address - Fax:517-482-5637
Practice Address - Street 1:2628 LAKE LANSING RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3668
Practice Address - Country:US
Practice Address - Phone:517-482-5636
Practice Address - Fax:517-482-5637
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010113401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice