Provider Demographics
NPI:1790083665
Name:PORRAS, SUSANA C (DMD)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:C
Last Name:PORRAS
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 1:11620 LOUETTA RD STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1282
Mailing Address - Country:US
Mailing Address - Phone:281-800-8852
Mailing Address - Fax:
Practice Address - Street 1:11620 LOUETTA RD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1282
Practice Address - Country:US
Practice Address - Phone:281-800-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0292501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery