| NPI | 1205693181 |
|---|---|
| Other Name | PORTAGE PEDIATRIC DENTISTRY PLC |
| Entity Type | Organization |
| Authorized Contact | CAROL GUEVARA Insurance COO Rdinator 616-264-4709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2024-03-06 |
| Last Update Date | 2024-03-06 |