Provider Demographics
NPI:1285379396
Name:PORTER, RACHEL (DMD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18326 BOWSPRIT POINTE RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5203
Mailing Address - Country:US
Mailing Address - Phone:704-877-6649
Mailing Address - Fax:
Practice Address - Street 1:3991 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5803
Practice Address - Country:US
Practice Address - Phone:713-490-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1859509122300000X
390200000X
TX409051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program