# HARBORSIDE DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Harborside Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114563012
- **Authorized official:** DR. MARK DAVID KRULL DDS (PARTNER)
- **Authorized official phone:** (231) 946-0207

## Contact information

- **Practice address:** 13300 S WEST BAY SHORE DR STE 1, TRAVERSE CITY, MI 49684-5571
- **Practice address phone:** (231) 946-0207
- **Mailing address:** 13300 S WEST BAY SHORE DR STE 1, TRAVERSE CITY, MI 49684-5571
- **Mailing address phone:** (231) 946-0207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/26/2019
- **Last updated:** 11/26/2019