# PORTABLE DENTAL SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437483484
- **Authorized official:** ROBERT VANCE ANTOLAK (PRESIDENT)
- **Authorized official phone:** (586) 873-5567

## Contact information

- **Practice address:** 15055 22 MILE RD \# 2, SHELBY TWP, MI 48315-4401
- **Practice address phone:** (586) 873-5567
- **Mailing address:** 15055 22 MILE RD \# 2, SHELBY TWP, MI 48315-4401
- **Mailing address phone:** (586) 873-5567

## Taxonomy

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

## Other

- **Enumeration date:** 09/23/2009
- **Last updated:** 09/23/2009