Provider Demographics
NPI:1154768414
Name:POGONCHEFF, ANNA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:POGONCHEFF
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 1:2628 LAKE LANSING RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3668
Mailing Address - Country:US
Mailing Address - Phone:517-482-5636
Mailing Address - Fax:517-482-5637
Practice Address - Street 1:2628 LAKE LANSING RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3668
Practice Address - Country:US
Practice Address - Phone:517-420-8893
Practice Address - Fax:517-482-5637
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist