Provider Demographics
NPI:1417362492
Name:PORTIS, SETH BNJAMIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:BNJAMIN
Last Name:PORTIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 FRANKLIN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-8229
Mailing Address - Country:US
Mailing Address - Phone:615-465-8030
Mailing Address - Fax:615-465-8059
Practice Address - Street 1:554 FRANKLIN RD STE 104
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-8229
Practice Address - Country:US
Practice Address - Phone:615-465-8030
Practice Address - Fax:615-465-8059
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000098681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice