Individual
JASON PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1721 E LINCOLN AVE, SUNNYSIDE, WA 98944-2478
(509) 837-7178
(509) 837-3117
Mailing address
1721 E LINCOLN AVE, SUNNYSIDE, WA 98944-2478
(509) 837-1778
(509) 837-3117
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0442000250
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DE60936198
WA
Other
Enumeration date
01/14/2016
Last updated
05/22/2019
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