Provider Demographics
NPI:1891881884
Name:PORTER, ALISHA BROOKE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:BROOKE
Last Name:PORTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PARK PL
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3230
Mailing Address - Country:US
Mailing Address - Phone:817-444-1763
Mailing Address - Fax:817-270-4076
Practice Address - Street 1:240 PARK PL
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3230
Practice Address - Country:US
Practice Address - Phone:817-444-1763
Practice Address - Fax:817-270-4076
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice