Provider Demographics
NPI:1780722306
Name:POGODA, DONALD ARTHUR (DMD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ARTHUR
Last Name:POGODA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-7308
Mailing Address - Country:US
Mailing Address - Phone:203-255-8913
Mailing Address - Fax:
Practice Address - Street 1:8 W END AVE
Practice Address - Street 2:OLD GREENWICH PROFESSIONAL BLDG.
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1642
Practice Address - Country:US
Practice Address - Phone:203-637-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice