Individual
DR. BRIAN DAVID PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5601 ODANA RD, MADISON, WI 53719-1207
(608) 222-3231
Mailing address
1622 STATION PARK DR, GRAYSLAKE, IL 60030-2720
(414) 628-3716
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6266-015
WI
Other
Enumeration date
08/06/2008
Last updated
06/18/2013
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