Individual
GELISE MARIE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2807 W THOMAS ST, HAMMOND, LA 70401-2840
(985) 602-2716
Mailing address
705 JEFFERSON ST UNIT 114, LAFAYETTE, LA 70501-6937
(318) 730-3539
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
38855
TX
1223G0001X
General Practice Dentistry
Primary
7249
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2021
Last updated
07/10/2024
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