Provider Demographics
NPI:1821381989
Name:POGONCHEFF, JOHN METODI (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:METODI
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 STE 101
Mailing Address - Street 2:
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 STE 101
Practice Address - Street 2:
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?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist