Provider Demographics
NPI:1235218686
Name:PORTILLA, MARIA (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PORTILLA
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 1:8150 ROYAL PALM BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5704
Mailing Address - Country:US
Mailing Address - Phone:954-344-0445
Mailing Address - Fax:954-344-2840
Practice Address - Street 1:8150 ROYAL PALM BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5704
Practice Address - Country:US
Practice Address - Phone:954-344-0445
Practice Address - Fax:954-344-2840
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN121921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry