West Milham Dental Prof PC

NPI #1194817734 in Portage, Michigan

Provider Information

NPI Number: 1194817734
Entity Type: Organization
Organization Name: West Milham Dental Prof PC
Primary Specialty: Dentist
Enumeration Date: Sep 29, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 1416 W MILHAM
City: Portage
State: Michigan
ZIP Code: 49024-2245
Phone: (269) 381-0564

Authorized Official

Name: DR. MARY ANN BUKOWSKI, DDS
Title: OWNER DENTIST
Phone: (269) 381-0564

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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