Individual
DR. ALLEN STUCKEY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD,MS
Contact information
Practice address
2824 ROGERS RD, SUITE 201, WAKE FOREST, NC 27587-3895
(919) 435-7660
(919) 453-6370
Mailing address
2824 ROGERS RD, SUITE 201, WAKE FOREST, NC 27587-3895
(919) 435-7660
(919) 453-6370
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
03940
SC
1223P0221X
Pediatric Dentistry
0647
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX3940
—
SC
Enumeration date
01/18/2007
Last updated
06/03/2008
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