Individual
AUDREY ALANNA PORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3502 AVALON PARK WEST BLVD, ORLANDO, FL 32828-7859
(407) 392-9868
Mailing address
12455 NATURE EAST DR, ORLANDO, FL 32828-8049
(804) 432-9728
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN25212
FL
Other
Enumeration date
05/27/2020
Last updated
07/07/2021
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