Provider Demographics
NPI:1457900094
Name:ROBERT L PORTER, DDS, PA
Entity Type:Organization
Organization Name:ROBERT L PORTER, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-699-0002
Mailing Address - Street 1:660 W CAMPBELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3396
Mailing Address - Country:US
Mailing Address - Phone:972-699-0002
Mailing Address - Fax:
Practice Address - Street 1:660 W CAMPBELL RD STE 101
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3396
Practice Address - Country:US
Practice Address - Phone:972-699-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT L PORTER, DDS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies