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General NPI Number Information
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NPI Number | 1043741424
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Entity Type | Organization
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Legal Business Name | PORT CITY DENTAL
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 1848 E SHERMAN BLVD SUITE C
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City | MUSKEGON
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State | MI
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Zip | 49444-1963
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Country | US
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Telephone | 231-737-7745
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Fax | 231-737-3296
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Provider Business Mailing Address
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Address Line | 1848 E SHERMAN BLVD SUITE C
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City | MUSKEGON
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State | MI
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Zip | 49444-1963
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Country | US
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Telephone | 231-737-7745
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Fax | 231-737-3296
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Authorized Official
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Title or Position | INSURANCE SPECIALIST
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Name | TERESA BEER
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Credential |
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Telephone | 231-865-6945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | MI
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