Provider Demographics
NPI:1043741424
Name:PORT CITY DENTAL
Entity Type:Organization
Organization Name:PORT CITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-865-6945
Mailing Address - Street 1:1848 E SHERMAN BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1963
Mailing Address - Country:US
Mailing Address - Phone:231-737-7745
Mailing Address - Fax:231-737-3296
Practice Address - Street 1:1848 E SHERMAN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1963
Practice Address - Country:US
Practice Address - Phone:231-737-7745
Practice Address - Fax:231-737-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty