Organization
PORTABLE DENTAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT VANCE ANTOLAK (PRESIDENT)
(586) 873-5567
Entity
Organization
Contact information
Practice address
15055 22 MILE RD # 2, SHELBY TWP, MI 48315-4401
(586) 873-5567
Mailing address
15055 22 MILE RD # 2, SHELBY TWP, MI 48315-4401
(586) 873-5567
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/23/2009
Last updated
09/23/2009
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