Provider Demographics
NPI:1922097575
Name:PORRATA DORIA, ENID (DMD)
Entity Type:Individual
Prefix:DR
First Name:ENID
Middle Name:
Last Name:PORRATA DORIA
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 1:101-103 E. LEHIGH AVE.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1011
Mailing Address - Country:US
Mailing Address - Phone:215-427-0405
Mailing Address - Fax:215-427-0138
Practice Address - Street 1:101-103 E. LEHIGH AVE.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1011
Practice Address - Country:US
Practice Address - Phone:215-427-0405
Practice Address - Fax:215-427-0138
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-023728L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice