Provider Demographics
NPI:1689628604
Name:PORTER, MARTIN, SALMAN, P.A.
Entity Type:Organization
Organization Name:PORTER, MARTIN, SALMAN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-596-9099
Mailing Address - Street 1:94 BRICK RD
Mailing Address - Street 2:WEST JERSEY MEDICAL PLAZA STE. 100
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2179
Mailing Address - Country:US
Mailing Address - Phone:856-596-9099
Mailing Address - Fax:856-983-5946
Practice Address - Street 1:94 BRICK RD
Practice Address - Street 2:WEST JERSEY MEDICAL PLAZA STE. 100
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2179
Practice Address - Country:US
Practice Address - Phone:856-596-9099
Practice Address - Fax:856-983-5946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI144821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091839Medicare ID - Type Unspecified