MEDICARE: DR. LORI BETH PORRAS D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN 19624	FL
2	1223P0221X	Pediatric Dentistry	9567	SC

General Provider Information

NPI Number	:	1750636569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI BETH PORRAS D.M.D.

Provider Business Mailing Address
First Line	:	584 STARLIT WAY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4322
Country	:	US
Telephone Number	:	954-383-3893
Fax Number	:

Provider Business Practice Location Address
First Line	:	4603 OLEANDER DR STE 3
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5738
Country	:	US
Telephone Number	:	843-353-3319
Fax Number	:	843-353-3238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	05/30/2024

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