Organization
PORTAGE NORTHERN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE HEISE (INSURANCE SPECIALIST)
(231) 246-2204
Entity
Organization
Contact information
Practice address
1220 W MILHAM AVE, PORTAGE, MI 49024-1206
(269) 382-5040
Mailing address
1220 W MILHAM AVE, PORTAGE, MI 49024-1206
(269) 382-5040
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/18/2022
Last updated
01/18/2022
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