Organization
THE PORTLAND DENTAL PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERESA M WATKINS DDS (DENTIST)
(260) 726-4710
Entity
Organization
Contact information
Practice address
112 N SHIP ST, PORTLAND, IN 47371-1844
(260) 726-4710
(260) 726-7051
Mailing address
112 N SHIP ST, PORTLAND, IN 47371-1844
(260) 726-4710
(260) 726-7051
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010271A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200888510
—
IN
05
—
200962440
—
IN
Enumeration date
12/07/2011
Last updated
12/07/2011
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