| Portage Dental Center | |
|
250 S Chestnut St Ste 30 Ravenna OH 44266-3031 | |
| (330) 297-7009 | |
| (330) 297-0901 |
| Full Name | Portage Dental Center |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 250 S Chestnut St Ste 30, Ravenna, Ohio |
| Authorized Official Name and Position | Ann Harry (OFFICE ADMINISTRATOR MGR) |
| Authorized Official Contact | 3302977009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portage Dental Center 250 S Chestnut St Ste 30 Ravenna OH 44266-3031 Ph: (330) 297-7009 | Portage Dental Center 250 S Chestnut St Ste 30 Ravenna OH 44266-3031 Ph: (330) 297-7009 |
| NPI Number | 1316093024 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 02/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316093024 | NPI | - | NPPES |
| 0468597 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Portage Dental Group, Jeffrey S. Rosenthal D.d.s., Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 644 S Chestnut St, Ravenna, OH 44266 Phone: 330-297-7009 |