# LAGRANGE FAMILY DENTISTRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BONTRAGER FAMILY DENTISTRY LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1710757471
- **Legal business name:** BONTRAGER FAMILY DENTISTRY LLC
- **Authorized official:** DR. KALYSSA BONTRAGER (OWNER/ DOCTOR)
- **Authorized official phone:** (260) 463-2111

## Contact information

- **Practice address:** 612 S DETROIT ST, LAGRANGE, IN 46761-2314
- **Practice address phone:** (260) 463-2111
- **Mailing address:** 612 S DETROIT ST, LAGRANGE, IN 46761-2314

## Taxonomy

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

## Other

- **Enumeration date:** 01/04/2024
- **Last updated:** 01/04/2024