Provider Demographics
NPI:1417448192
Name:PORTWOOD, SABRINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:
Last Name:PORTWOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SABRINA
Other - Middle Name:PORTWOOD
Other - Last Name:O'SHEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9069 SIEGEN LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1951
Mailing Address - Country:US
Mailing Address - Phone:225-766-8371
Mailing Address - Fax:
Practice Address - Street 1:9069 SIEGEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1951
Practice Address - Country:US
Practice Address - Phone:225-766-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist