Provider Demographics
NPI:1346404712
Name:JAMES W. PORTER II, DMD, LLC
Entity Type:Organization
Organization Name:JAMES W. PORTER II, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-879-9200
Mailing Address - Street 1:100 ANDREW ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-1964
Mailing Address - Country:US
Mailing Address - Phone:256-878-9200
Mailing Address - Fax:256-878-9200
Practice Address - Street 1:100 ANDREW ST STE A
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1964
Practice Address - Country:US
Practice Address - Phone:256-878-9200
Practice Address - Fax:256-878-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL008406370Medicaid