Provider Demographics
NPI:1891088258
Name:PORTER, SHARYL ANN (IPDH)
Entity Type:Individual
Prefix:MS
First Name:SHARYL
Middle Name:ANN
Last Name:PORTER
Suffix:
Gender:F
Credentials:IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MOUNT BATTIE ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1519
Mailing Address - Country:US
Mailing Address - Phone:207-542-7133
Mailing Address - Fax:
Practice Address - Street 1:748 MAIN ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4683
Practice Address - Country:US
Practice Address - Phone:207-563-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist