Individual
RAYMOND J PORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
705 FIFTH AVE, ANTIGO, WI 54409
(715) 623-5331
(715) 627-1852
Mailing address
705 FIFTH AVE, ANTIGO, WI 54409
(715) 623-5331
(715) 627-1852
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1825E
WI
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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