Provider Demographics
NPI:1699826354
Name:PORTIA D TURNER D D S
Entity Type:Organization
Organization Name:PORTIA D TURNER D D S
Other - Org Name:DR.PORTIA D TURNER DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PORTIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DENTAL
Authorized Official - Phone:310-412-2994
Mailing Address - Street 1:139 N PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1904
Mailing Address - Country:US
Mailing Address - Phone:310-412-2994
Mailing Address - Fax:310-412-2076
Practice Address - Street 1:139 N PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1904
Practice Address - Country:US
Practice Address - Phone:310-412-2994
Practice Address - Fax:310-412-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000109036OtherAETNA DMO
CA005593OtherDELTA CARE PMI
CAB3503601Medicare ID - Type UnspecifiedMEDICAL