Provider Demographics
NPI:1952502817
Name:DEANNA M. PONIATOWSKI
Entity Type:Organization
Organization Name:DEANNA M. PONIATOWSKI
Other - Org Name:CRESTVIEW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PONIATOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DD,S
Authorized Official - Phone:586-226-9000
Mailing Address - Street 1:46600 ROMEO PLANK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5741
Mailing Address - Country:US
Mailing Address - Phone:586-226-9000
Mailing Address - Fax:586-226-3370
Practice Address - Street 1:46600 ROMEO PLANK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5741
Practice Address - Country:US
Practice Address - Phone:586-226-9000
Practice Address - Fax:586-226-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty