Bontrager Family Dentistry LLC

NPI #1366001679 in Lagrange, Indiana

Provider Information

NPI Number: 1366001679
Entity Type: Organization
Organization Name: Bontrager Family Dentistry LLC
Primary Specialty: Dentist
Enumeration Date: Jun 10, 2019
Last Updated: Jun 10, 2019

Practice Location

Address: 612 S DETROIT ST
City: Lagrange
State: Indiana
ZIP Code: 46761-2314
Phone: (260) 463-2111

Authorized Official

Name: DR. KALYSSA MAE BONTRAGER, DDS
Title: OWNER DENTIST
Phone: (260) 580-5246

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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