Individual
DR. IRIVELISSE STEVENS PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
12086 FORT CAROLINE RD, SUITE 105, JACKSONVILLE, FL 32225-2687
(904) 807-9127
Mailing address
5077 CREEK CROSSING DR, JACKSONVILLE, FL 32226-4779
(904) 463-4531
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19714
FL
Other
Enumeration date
07/19/2012
Last updated
07/19/2012
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