Provider Demographics
NPI:1851953053
Name:POGODZINSKI, OLIVIA LOUISE (DDS)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LOUISE
Last Name:POGODZINSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15285 WATERTOWN PLANK ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122
Mailing Address - Country:US
Mailing Address - Phone:262-649-4900
Mailing Address - Fax:262-649-4844
Practice Address - Street 1:7020 W NATIONAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-475-0588
Practice Address - Fax:414-475-1166
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10021271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice