Provider Demographics
NPI:1609097765
Name:PIONTKOWSKI, CCARL S (DD)
Entity Type:Individual
Prefix:
First Name:CCARL
Middle Name:S
Last Name:PIONTKOWSKI
Suffix:
Gender:M
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42657 GARFIELD RD STE 214
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5023
Mailing Address - Country:US
Mailing Address - Phone:586-263-5540
Mailing Address - Fax:586-263-7057
Practice Address - Street 1:42657 GARFIELD RD STE 214
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5023
Practice Address - Country:US
Practice Address - Phone:586-263-5540
Practice Address - Fax:586-263-7057
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15640122300000X
MI2901015640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist