Provider Demographics
NPI:1649298902
Name:PORTER, ARTHUR JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:JOHN
Last Name:PORTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:17100 E SHEA BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6653
Mailing Address - Country:US
Mailing Address - Phone:480-816-6537
Mailing Address - Fax:480-816-0857
Practice Address - Street 1:17100 E SHEA BLVD STE 450
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6653
Practice Address - Country:US
Practice Address - Phone:480-816-6537
Practice Address - Fax:480-816-0857
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice