Provider Demographics
NPI:1518173277
Name:PORCARO, CARLO J (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLO
Middle Name:J
Last Name:PORCARO
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 1:228 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5950
Mailing Address - Country:US
Mailing Address - Phone:973-680-9205
Mailing Address - Fax:
Practice Address - Street 1:228 N 15TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5950
Practice Address - Country:US
Practice Address - Phone:973-680-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD 184431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice