Provider Demographics
NPI:1376586321
Name:PORET, HARRIS LIONEL (DDS)
Entity Type:Individual
Prefix:
First Name:HARRIS
Middle Name:LIONEL
Last Name:PORET
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 1:1115 LEVEE RD
Mailing Address - Street 2:P.O. BOX 46
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:LA
Mailing Address - Zip Code:71366-6639
Mailing Address - Country:US
Mailing Address - Phone:318-766-1967
Mailing Address - Fax:318-766-9090
Practice Address - Street 1:1115 LEVEE RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:LA
Practice Address - Zip Code:71366-6639
Practice Address - Country:US
Practice Address - Phone:318-766-1967
Practice Address - Fax:318-766-9090
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1815942Medicare ID - Type Unspecified