Organization
NATE PORTER DDS PLC
Active
Other names
Brown Road Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHAN R PORTER DDS (CEO)
(480) 834-6100
Entity
Organization
Contact information
Practice address
855 E BROWN RD STE 4, MESA, AZ 85203-4958
(480) 834-6100
Mailing address
855 E BROWN RD STE 4, MESA, AZ 85203-4958
(480) 834-6100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7582
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350633
—
AZ
Enumeration date
05/14/2012
Last updated
05/14/2012
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