Provider Demographics
NPI:1578561056
Name:PORTER, WILLIAM A (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:PORTER
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:408 LANCASTER DR NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4728
Mailing Address - Country:US
Mailing Address - Phone:503-362-3032
Mailing Address - Fax:503-362-4647
Practice Address - Street 1:1880 LANCASTER DR NE
Practice Address - Street 2:SUITE 104
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1089
Practice Address - Country:US
Practice Address - Phone:503-587-9949
Practice Address - Fax:503-587-9972
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR50901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR042783Medicaid