Provider Demographics
NPI:1154342152
Name:DRS PORTER & CARROLL PC
Entity type:Organization
Organization Name:DRS PORTER & CARROLL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-725-8901
Mailing Address - Street 1:7946 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3321
Mailing Address - Country:US
Mailing Address - Phone:215-725-8901
Mailing Address - Fax:215-725-8951
Practice Address - Street 1:7946 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3321
Practice Address - Country:US
Practice Address - Phone:215-725-8901
Practice Address - Fax:215-725-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA732043OtherU/C PROVIDER NUMBER