Individual
DR. KALYSSA MAE BONTRAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
612 S DETROIT ST, LAGRANGE, IN 46761-2314
(260) 463-2111
Mailing address
PO BOX 183, STROH, IN 46789-0183
(260) 580-5246
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12013143A
IN
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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