Individual
MRS. BRENDA YVONNE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2121 6TH AVE, TROY, NY 12180
(845) 853-6468
Mailing address
10 LAKEVIEW AVE, KINGSTON, NY 12401-4710
(845) 853-6468
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
044491
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01568836
—
NY
Enumeration date
03/07/2007
Last updated
06/13/2011
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