| Port Pediatric Dentistry Pc | |
|
291 W Lakewood Blvd Holland MI 49424-1969 | |
| (616) 392-1100 | |
| (616) 396-1117 |
| Full Name | Port Pediatric Dentistry Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 291 W Lakewood Blvd, Holland, Michigan |
| Authorized Official Name and Position | Suzanne Kristen Port (DENTIST/OWNER) |
| Authorized Official Contact | 6163921100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Port Pediatric Dentistry Pc 291 W Lakewood Blvd Holland MI 49424-1969 Ph: (616) 392-1100 | Port Pediatric Dentistry Pc 291 W Lakewood Blvd Holland MI 49424-1969 Ph: (616) 392-1100 |
| NPI Number | 1669080651 |
|---|---|
| Provider Enumeration Date | 07/16/2020 |
| Last Update Date | 07/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669080651 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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