Provider Demographics
NPI:1609870005
Name:PORTNOFF, HERBERT H (DDS)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:H
Last Name:PORTNOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2805
Mailing Address - Country:US
Mailing Address - Phone:732-549-3773
Mailing Address - Fax:732-549-9241
Practice Address - Street 1:1656 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2805
Practice Address - Country:US
Practice Address - Phone:732-549-3773
Practice Address - Fax:732-549-9241
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1007129001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry