| West Milham Dental Prof Pc | |
|
1416 W Milham Portage MI 49024-2245 | |
| (269) 381-0564 | |
| (269) 381-4965 |
| Full Name | West Milham Dental Prof Pc |
|---|---|
| Speciality | Dentist |
| Location | 1416 W Milham, Portage, Michigan |
| Authorized Official Name and Position | Mary Ann Bukowski (OWNER DENTIST) |
| Authorized Official Contact | 2693810564 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Milham Dental Prof Pc 1416 W Milham Portage MI 49024-2245 Ph: (269) 381-0564 | West Milham Dental Prof Pc 1416 W Milham Portage MI 49024-2245 Ph: (269) 381-0564 |
| NPI Number | 1194817734 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194817734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2901011980 (Michigan) | Primary |
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