Provider Demographics
NPI:1467679407
Name:PORTER, MARY ISABELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ISABELLE
Last Name:PORTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4987 RINGWOOD MEADOW
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-2033
Mailing Address - Country:US
Mailing Address - Phone:941-377-3659
Mailing Address - Fax:941-378-0893
Practice Address - Street 1:4987 RINGWOOD MEADOW
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-2033
Practice Address - Country:US
Practice Address - Phone:941-377-3659
Practice Address - Fax:941-378-0893
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist