Organization
PORT PEDIATRIC DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUZANNE KRISTEN PORT DDS,MS (DENTIST/OWNER)
(616) 392-1100
Entity
Organization
Contact information
Practice address
291 W LAKEWOOD BLVD, HOLLAND, MI 49424-1969
(616) 392-1100
(616) 396-1117
Mailing address
291 W LAKEWOOD BLVD, HOLLAND, MI 49424-1969
(616) 392-1100
(616) 396-1117
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
07/16/2020
Last updated
07/16/2020
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