Provider Demographics
NPI:1487965729
Name:PORATH, NATHAN CARL (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CARL
Last Name:PORATH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 HERITAGE PL
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5248
Mailing Address - Country:US
Mailing Address - Phone:507-334-7595
Mailing Address - Fax:
Practice Address - Street 1:412 HERITAGE PL
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5248
Practice Address - Country:US
Practice Address - Phone:507-334-7595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND128281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice