Provider Demographics
NPI:1982671822
Name:PORTER, JAMES F (DMD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:F
Last Name:PORTER
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 1:301 DR CARTER BLVD
Mailing Address - Street 2:PO BOX 847
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-6212
Mailing Address - Country:US
Mailing Address - Phone:386-437-7350
Mailing Address - Fax:386-437-8207
Practice Address - Street 1:301 DR CARTER BLVD
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-6212
Practice Address - Country:US
Practice Address - Phone:386-437-7350
Practice Address - Fax:386-437-8207
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN170591223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076013700Medicaid