Provider Demographics
NPI:1932266814
Name:PORRO, MERCEDES MARIA (DDS)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:MARIA
Last Name:PORRO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PROGRESS ST
Mailing Address - Street 2:SUITE A2
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:201-797-5656
Mailing Address - Fax:201-797-1665
Practice Address - Street 1:4 PROGRESS ST
Practice Address - Street 2:SUITE A2
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:201-797-5656
Practice Address - Fax:201-797-1665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20373122300000X
NJ51281223P0700X
NJ203731223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics