Individual
DR. AUSTIN PORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
15 BRIGANTINE ST, BEACHWOOD, NJ 08722-2900
(732) 581-9301
Mailing address
15 BRIGANTINE ST, BEACHWOOD, NJ 08722-2900
(732) 581-9301
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02648300
NJ
Other
Enumeration date
09/30/2015
Last updated
08/08/2016
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