Provider Demographics
NPI:1588984298
Name:PORTER DENTISTRY, P.C.
Entity type:Organization
Organization Name:PORTER DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONIA-MARIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-449-3222
Mailing Address - Street 1:1633 W MAIN ST # 200
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3423
Mailing Address - Country:US
Mailing Address - Phone:615-449-3222
Mailing Address - Fax:615-449-3202
Practice Address - Street 1:1633 W MAIN ST # 200
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3423
Practice Address - Country:US
Practice Address - Phone:615-449-3222
Practice Address - Fax:615-449-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530741Medicaid