| NPI | 1366817827 |
|---|---|
| Doing Business As | PORTAGE PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | JODY L WRATHALL Owner 269-323-8016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901020339) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901009877) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2015-12-09 |