Organization
PORTAGE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANN HARRY (OFFICE ADMINISTRATOR MGR)
(330) 297-7009
Entity
Organization
Contact information
Practice address
250 S CHESTNUT ST STE 30, RAVENNA, OH 44266-3031
(330) 297-7009
(330) 297-0901
Mailing address
250 S CHESTNUT ST STE 30, RAVENNA, OH 44266-3031
(330) 297-7009
(330) 297-0901
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0468597
—
OH
Enumeration date
01/26/2007
Last updated
02/19/2014
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