# BONTRAGER FAMILY DENTISTRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Firefly Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366001679
- **Authorized official:** DR. KALYSSA MAE BONTRAGER DDS (OWNER DENTIST)
- **Authorized official phone:** (260) 580-5246

## Contact information

- **Practice address:** 612 S DETROIT ST, LAGRANGE, IN 46761-2314
- **Practice address phone:** (260) 463-2111
- **Mailing address:** PO BOX 183, STROH, IN 46789-0183
- **Mailing address phone:** (260) 580-5246

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 06/10/2019
- **Last updated:** 06/10/2019