Provider Demographics
NPI:1699405134
Name:PORCELLI, EMILY LOUISE (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:LOUISE
Last Name:PORCELLI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 PRIMROSE LN # A-B
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1229
Mailing Address - Country:US
Mailing Address - Phone:717-285-3030
Mailing Address - Fax:
Practice Address - Street 1:313 PRIMROSE LN # A-B
Practice Address - Street 2:
Practice Address - City:MOUNTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17554-1229
Practice Address - Country:US
Practice Address - Phone:717-285-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044092122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program