| NPI | 1417150137 |
|---|---|
| Doing Business As | PORTAGE DENTAL REHAB CENTER |
| Entity Type | Organization |
| Authorized Contact | CRESHINDA DENISE AYANGADE Dentist 219-764-4004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2020-08-22 |