Provider Demographics
NPI:1750429528
Name:PORTELL, FRANK R (DMD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:R
Last Name:PORTELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2135 HARPOON DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-2329
Mailing Address - Country:US
Mailing Address - Phone:540-720-6754
Mailing Address - Fax:540-720-7160
Practice Address - Street 1:6120 BRANDON AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2522
Practice Address - Country:US
Practice Address - Phone:703-569-0000
Practice Address - Fax:703-569-8758
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA79311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics