Provider Demographics
NPI:1801029905
Name:DRS. PORAC & BACHTELL FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:DRS. PORAC & BACHTELL FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PORAC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-739-8081
Mailing Address - Street 1:1125 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5857
Mailing Address - Country:US
Mailing Address - Phone:301-739-8081
Mailing Address - Fax:301-739-8082
Practice Address - Street 1:1125 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5857
Practice Address - Country:US
Practice Address - Phone:301-739-8081
Practice Address - Fax:301-739-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6964261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental