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Individual
DR. P MARK PORTNOY
Active
Individual
DR. P MARK PORTNOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
27353
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27353
DENTAL LICENSE
CA
01
—
95-3912311
TAX ID
—
Enumeration date
11/08/2006
Last updated
07/07/2011
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