Provider Demographics
NPI:1679349302
Name:DENTISTRY AT PORTAGE LAKES
Entity Type:Organization
Organization Name:DENTISTRY AT PORTAGE LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-614-9511
Mailing Address - Street 1:667 W TURKEYFOOT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44319-3452
Mailing Address - Country:US
Mailing Address - Phone:330-644-9511
Mailing Address - Fax:
Practice Address - Street 1:667 W TURKEYFOOT LAKE RD
Practice Address - Street 2:
Practice Address - City:NEW FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:44319-3452
Practice Address - Country:US
Practice Address - Phone:330-644-9511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental