Individual
DR. PHILLIP CHARLES PORTERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
301 FISHER ST, KEESLER AFB, MS 39534-2508
(228) 376-0511
Mailing address
301 FISHER ST, KEESLER AFB, MS 39534-2508
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2630-91
MS
1223G0001X
General Practice Dentistry
Primary
2630-91
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2630-91
DENTAL
MS
Enumeration date
10/20/2005
Last updated
04/30/2018
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