Organization
BRENT J. PORTER, D.D.S., M.S., A P.D.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT JOSEPH PORTER D.D.S., M.S. (PRESIDENT-DENTIST)
(831) 459-9802
Entity
Organization
Contact information
Practice address
550 WATER ST, SUITE D NUMBER 1, SANTA CRUZ, CA 95060-4124
(831) 459-9802
(831) 459-8234
Mailing address
PO BOX 580, APTOS, CA 95001-0580
(831) 459-9802
(831) 459-8234
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
39322
CA
1223P0221X
Pediatric Dentistry
39322
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
39322
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B39322
DENTICAL
CA
Enumeration date
05/04/2007
Last updated
09/11/2025
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