Provider Demographics
NPI:1669513164
Name:PORRAS, OMAR D (DMD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:D
Last Name:PORRAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E EVESHAM RD
Mailing Address - Street 2:SUITE 608
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4501
Mailing Address - Country:US
Mailing Address - Phone:856-520-8212
Mailing Address - Fax:856-520-8215
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:SUITE 608
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-520-8212
Practice Address - Fax:856-520-8215
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021315011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics