Individual
DR. BRADFORD J. PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
94 BRICK RD, WEST JERSEY MEDICAL PLAZA SUITE 100, MARLTON, NJ 08053-2179
(856) 596-9099
(856) 596-6715
Mailing address
94 BRICK RD, WEST JERSEY MEDICAL PLAZA SUITE 100, MARLTON, NJ 08053-2179
(856) 596-9099
(856) 596-6715
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DI14482
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1126903
—
NJ
Enumeration date
10/06/2005
Last updated
07/08/2007
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