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General NPI Number Information
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NPI Number | 1417150137
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Entity Type | Organization
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Legal Business Name | MICHIGAN CITY FAMILY DENTISTRY
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6044 LUTE RD
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City | PORTAGE
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State | IN
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Zip | 46368-5008
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Country | US
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Telephone | 219-764-4004
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Fax | 219-764-4031
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Provider Business Mailing Address
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Address Line | 6044 LUTE RD
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City | PORTAGE
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State | IN
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Zip | 46368-5008
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Country | US
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Telephone | 219-764-4004
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Fax | 219-764-4031
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CRESHINDA DENISE AYANGADE
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Credential | DMD
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Telephone | 219-764-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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