Individual
EDILEIA PORCARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1806 OVER LAKE DR SE, CONYERS, GA 30013-1745
(770) 760-7900
(770) 760-1375
Mailing address
1806 OVER LAKE DR SE, CONYERS, GA 30013-1745
(770) 760-7900
(770) 760-1375
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN014329
GA
Other
Enumeration date
08/22/2011
Last updated
08/22/2011
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