Provider Demographics
NPI:1871908350
Name:OGONOWSKI, MICHELLE T (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:T
Last Name:OGONOWSKI
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 1:1373 YMCA DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2617
Mailing Address - Country:US
Mailing Address - Phone:636-937-6565
Mailing Address - Fax:
Practice Address - Street 1:1373 YMCA DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2617
Practice Address - Country:US
Practice Address - Phone:636-937-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014016658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist