Individual
MAHOGANY FAYE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2900 CANTON ST, DALLAS, TX 75226-1792
(469) 922-3181
Mailing address
2900 CANTON ST, DALLAS, TX 75226-1792
(469) 922-3181
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
1776906
TX
Other
Enumeration date
08/22/2022
Last updated
09/25/2022
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