Provider Demographics
NPI:1063911063
Name:PONIEWIERSKI, CHERYL ANN (RDH)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:PONIEWIERSKI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:ADACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:606 N. MAIN PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-0446
Mailing Address - Country:US
Mailing Address - Phone:810-798-8585
Mailing Address - Fax:
Practice Address - Street 1:606 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALMONT
Practice Address - State:MI
Practice Address - Zip Code:48003-8553
Practice Address - Country:US
Practice Address - Phone:810-798-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist