Provider Demographics
NPI:1558567552
Name:PORTER DENTAL HEALTH CLINIC, PA
Entity Type:Organization
Organization Name:PORTER DENTAL HEALTH CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:YAHODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-624-2778
Mailing Address - Street 1:1919 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7753
Mailing Address - Country:US
Mailing Address - Phone:501-624-2778
Mailing Address - Fax:501-321-9774
Practice Address - Street 1:1919 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7753
Practice Address - Country:US
Practice Address - Phone:501-624-2778
Practice Address - Fax:501-321-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty