MEDICARE: DENTISTRY AT PORTAGE LAKES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1679349302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTRY AT PORTAGE LAKES

Provider Business Mailing Address
First Line	:	667 W TURKEYFOOT LAKE RD
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44319-3452
Country	:	US
Telephone Number	:	330-644-9511
Fax Number	:

Provider Business Practice Location Address
First Line	:	667 W TURKEYFOOT LAKE RD
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44319-3452
Country	:	US
Telephone Number	:	330-644-9511
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KYLE WESTHAFER
Credential	:	DDS
Telephone Number	:	330-614-9511

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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Directions to “DENTISTRY AT PORTAGE LAKES ” Practice Location

Language	Start Address	Practice Location

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