Provider Demographics
NPI:1619680485
Name:PORCO FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:PORCO FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:PORCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-825-9973
Mailing Address - Street 1:200 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-2011
Mailing Address - Country:US
Mailing Address - Phone:814-776-1293
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-2011
Practice Address - Country:US
Practice Address - Phone:814-776-1293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty