Individual
DR. BRADLEY THAIN PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6755 E SUPERSTITION SPRINGS BLVD, SUITE 103, MESA, AZ 85206-4373
(480) 830-5866
(480) 807-0606
Mailing address
6755 E SUPERSTITION SPRINGS BLVD, SUITE 103, MESA, AZ 85206-4373
(480) 830-5866
(480) 807-0606
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4124
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2173766
—
AZ
01
—
AZ0482170
BCBS
AZ
Enumeration date
12/23/2005
Last updated
12/04/2018
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