Provider Demographics
NPI:1659500783
Name:PORRAS, JOSE RAFAEL (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAFAEL
Last Name:PORRAS
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 W MCNAB RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3242
Mailing Address - Country:US
Mailing Address - Phone:954-722-1100
Mailing Address - Fax:
Practice Address - Street 1:8333 W MCNAB RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3242
Practice Address - Country:US
Practice Address - Phone:954-722-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21946122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program