Provider Demographics
NPI:1326173659
Name:PORTER & ASSOCIATES DDS PC
Entity Type:Organization
Organization Name:PORTER & ASSOCIATES DDS PC
Other - Org Name:JEFFREY L PORTER DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-547-9516
Mailing Address - Street 1:201 BRIDGE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720
Mailing Address - Country:US
Mailing Address - Phone:231-547-9516
Mailing Address - Fax:
Practice Address - Street 1:201 BRIDGE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720
Practice Address - Country:US
Practice Address - Phone:231-547-9516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315008824OtherST BOARD OF PHARMACY
BP7707283OtherFEDERAL DEA